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THE MENTAL HEALTH 
OF THE SCHOOL CHILD 



THE PSYCHO-EDUCATIONAL CLINIC IN 
RELATION TO CHILD WELFARE 

CONTRIBUTIONS TO A NEW SCIENCE 

OF ORTHOPHRENICS AND 

ORTHOSOMATICS 



y 



By 



J. E5 WALLACE WALLIN, Ph. D. 

Professor of Clinical Psychology and Director 

of Psycho-Educational Clinic, School of 

Education, University of Pittsburgh 

Director-Elect of Psycho-Educational Clinic 

St. Louis Public Schools 




New Haven: Yale University Press 

London : Humphrey Milford 

Oxford University Press 

MDCCCCXIV 



e.^' 






Copyright, 1914, by 
Yale University Press 



First printed June, 1914, 1000 copies 



JON 29 1914 



©CI,A374654 



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To 
G. STANLEY HALL 

Founder of the Modern Child Study Movement 

AND 

The World's Second Psychological Laboratory 



PREFACE 

The publication of these papers and addresses in a 
single volume was prompted, first of all, by the widespread 
interest which is rapidly manifesting itself in all sections 
of the country in the grave social and educational prob- 
lems which spring from the presence in every populous 
community of large numbers of mentally abnormal chil- 
dren. It is now generally recognized that many of the 
most vexatious problems in our present-day social economy 
are somehow bound up with the mental and educational 
abnormalities of childhood. Educators, physicians, sociolo- 
gists, penologists, criminologists, lawyers, clergymen, phi- 
lanthropists and parents, therefore, welcome any attempt 
to gain deeper scientific insight into the nature, extent 
and causes of the mental, moral and educational arrest, 
deviation or deficiency of children. The papers included 
in this collection aim to show in slight measure the aid 
which the practical psychologists and expert educational 
consultants hope to render in the important work of diag- 
nosing, identifying, studying and training feeble-minded, 
backward and mentally abnormal children in the schools. 

During the last three or four years the writer has pub- 
lished a number of experimental memoirs, articles and 
addresses in American and European periodicals dealing, 
from different points of view, with a common theme : the 
scientific study and the care and improvement of the 
mental and physical misfits in the schools, or, in a word, 
the conservation of child life. These studies when brought 
to a focus form a fairly unitary, but by no means a sym- 



Vlll 



PREFACE 



metrical or systematic, whole. The more systematic 
treatment of the study and training of mentally unusual 
children is reserved for later volumes. A practical motive 
for bringing together the studies of this volume is the 
fact that the demand for reprints has exhausted the supply 
of several of the articles. 

Most of the chapters of the book are reprinted, with the 
kind permission of the editors, from various periodicals. 
Several of the reprints, however, have been so completely 
revised that they constitute, in effect, new contributions, 
while the new chapters added contain important data 
which have recently been gathered at first-hand and which 
are nowhere else available. 

A certain amount of repetition is ordinarily unavoid- 
able in the pubhcation of a series of scattered studies which 
deal with very closely related topics. While many articles 
have been considerably abbreviated and others somewhat 
expanded — sometimes to the detriment of the unity of 
the individual articles — in order to avoid needless itera- 
tion, certain repetitions have been designedly retained, 
because there exist today among both lay and professional 
workers serious and widespread misapprehensions regard- 
ing the aims, functions and administrative affiliations of the 
psychological or psycho-educational clinic, regarding the 
qualifications of Binet testers, amateur psychologists, 
professionally trained clinical psychologists, 'special' 
teachers, nurses and physicians. Owing to these miscon- 
ceptions we are today tolerating and fostering a type of 
work in apphed psychology which often is scientifically 
barren and sometimes positively pernicious. Clinical psy- 
chology promises to make a very important contribution 
to the world's sum total of knowledge, but it is in its 
infancy, and, therefore, its development needs to be guided 



PREFACE ix 

into channels that are in accord with the highest stand- 
ards of scientific work. In view of the present situation — 
a situation which in many sections allows almost anyone 
to pose as a psychological or educational diagnostician — 
I believe that no apology is necessary for the repetitions 
which have been retained in this series of selected papers, 
or for the emphasis which I have given my most cherished 
convictions. 

J. E. W. W. 
January, 1914. 



CONTENTS 

Preface ........ vii 

Chapter I 

Medical and Psychological Inspection of School 

Children 1 

Chapter II 

The New Clinical Psychology and the Psycho- 

clinicist ....... 22 

Chapter III 
Clinical Psychology: What It Is and What It Is Not 121 

Chapter IV 
The Functions of the Psychological Clinic . . 137 

Chapter V 

The Distinctive Contribution of the Psycho-educa- 
tional Clinic to the School Hygiene Movement . 156 

Chapter VI 
Human Efficiency . . . . . . 166 

Chapter VII 

Eight Months of Psycho-clinical Research at the New 
Jersey State Village for Epileptics, with Some 
Results from the Binet-Simon Testing . . 182 

Chapter VIII 

The Present Status of the Binet-Simon Graded Tests 

of Intelligence . . . . . . 196 



xii CONTENTS 

Chapter IX 

Current Misconceptions in Regard to the Functions of 
Binet Testing and of Amateur Psychological 
Testers 209 

Chapter X 

Re-averments Respecting Psycho-clinical Norms and 

Scales of Development . . . . . 216 

Chapter XI 
Individual and Group Efficiency . . . . 231 

Chapter XII 

The Euthenical and Eugenical Aspects of Infant and 

Child Orthogenesis ..... 246 

Chapter XIII 

Experimental Oral Orthogenics: an Experimental 
Investigation of the Effects of Dental Treat- 
ment on Mental Efficiency .... 275 

Chapter XIV 

The Relation of Oral Hygiene to Efficient Mentation 

in Backward Children ..... 291 

Chapter XV 

Methods of Measuring the Orthophrenic Effects of 

the Removal of Physical Handicaps . . . 300 

Chapter XVI 

Medical and Dental Inspection in the Cleveland 

Schools 315 



CONTENTS xiii 

Chapter XVII 

Efficiency in School Organization and the Conserva- 
tion of the Mental Health of Children . . 337 

Chapter XVIII 

Public School Provisions for Mentally Unusual 

Children ....... 383 

Chapter XIX 

A Schema for the Clinical Study of Mentally and 

Educationally Unusual Children . . . 429 

Note to Chapter IV 447 

Index . . . . . . . .451 



CHAPTER I 

MEDICAL AND PSYCHOLOGICAL INSPECTION 
OF SCHOOL CHILDREN' 

The question as to the need of the inspection of school 
children for the detection of contagious and communicable 
diseases (e-g-, diphtheria, scarlet fever, measles, whooping- 
cough, chicken pox, smallpox, tuberculosis) may be said 
to be closed. All intelligent observers are agreed that 
the schools, unless properly medically supervised, may, and 
frequently do, become virulent foci for the dissemination of 
fatal community diseases. As a matter of fact, all 
enlightened urban communities in this country and in 
Europe have recognized this imperative need by providing 
some form of school inspection for the contagious child 
diseases. The modern school medical-inspection movement, 
indeed, began as a form of inspection for infectious dis- 
eases by officers of Boards of Health. 

But there is another function of school medical inspec- 
tion which is even more important for the proper develop- 
ment of the individual child, though this function is not so 
generally recognized; namely, the physical examination of 
school children for the detection of physical defects : de- 
fective vision, defective hearing, defective nasal breathing, 
adenoids, hypertrophied tonsils, cardiac diseases, defective 
teeth and palate, malnutrition, orthopedic defects, tuber- 
cular lymph nodes, lateral curvature of the spine, stoop 

1 Reprinted, with extensive alterations, from The Western Journal 
of Education (now The American School Master), 1909, pp. 433-446. 



2 MENTAL HEALTH OF SCHOOL CHILD 

shoulders, nervous exhaustion and pulmonary disease. 
We are just awakening to the necessity of this type of 
pupil inspection because we are just beginning to realize 
the extent to which cliildren are physically handicapped. 
The statistics of defective children, wherever gathered, are 
fairly appalling. Space permits reference to only a few 
American surveys. 

Of more than 5,000 school children examined in Los 
Angeles, 61 per cent suffered from defective eyesight, 31 
per cent from adenoids, 25 per cent from enlarged tonsils 
and 22 per cent from defective hearing. In Chicago in 
1909, 123,900 children were examined (this was not an 
ultimate examination, only the major defects being 
noticed), and of these 36 per cent had defective teeth, 22 
per cent enlarged tonsils, 13 per cent enlarged glands, 5.5 
per cent nasal defects, 3.5 per cent adenoids and 2.3 per 
cent hearing defects. In another examination of 3,963 
cliildren in the same city 60 per cent were said to need the 
attention of a physician, the most prominent defects re- 
quiring treatment being hypertrophied tonsils, enlarged 
glands and adenoids. Seventy-two and three-tenths per 
cent of 230,243 children examined in New York City in 
1911 were reported as requiring treatment. The per- 
centages of defects found were as follows : Defective teeth, 
59 per cent; hypertrophied tonsils, 15 per cent; defective 
nasal breathing, 11.9 per cent; defective vision, 10.6 per 
cent ; malnutrition, 2.5 per cent ; cardiac disease, .7 per 
cent ; defective hearing, .6 per cent ; orthopedic defects, 
.5 per cent; chorea, A per cent; pulmonary disease, .4 
per cent; tubercular lymph nodes, .2 per cent. Of 1,442 
children, largely of Irish, Jewish and Italian stock, 
examined in three schools in this city in 1908, 73 per cent 
suffered from defective teeth, 59 per cent from nasal 



INSPECTION OF SCHOOL CHILDREN 3 

breathing, 42 per cent from visual defects, 39 per cent 
from hypertrophied tonsils and 15 per cent from anemia. 
Based upon another medical census of 23,000 children in 
all grades, the following distribution was found at the ages 
of six and fifteen: 

At 6 years At 15 years 

Defective teeth 65 per cent 31 per cent 

Enlarged tonsils 40 14 

Enlarged glands 40 7 

Adenoids 23 3 

Defective breathing 23 9 

Defective vision 17 26 

About 80 per cent of these children were physically defect- 
ive in some way. Gland, mouth and throat troubles, it 
will be observed, are typical cliildhood infirmities, while 
defective vision (as well as defective teeth) constitutes the 
bane of youth. In Worcester, 758 pupils examined in 
two elementary schools showed enlarged glands in 64.5 
per cent of the cases, affected tonsils in 37 per cent, ade- 
noids ('suspected') in 21 per cent, eye defects in 15 per 
cent, anemia in 4.5 per cent, poor nutrition in 5.5 per cent, 
medium nutrition in 36 per cent and good nutrition in 
57.5 per cent. Decayed teeth were found in 86.5 per cent 
of the pupils, the average number per child being 4.85, and 
the corresponding averages in the different grades (given 
in order from the first to the ninth grade), 7, 6.54, 6.08, 
4.90, 4, 3.50, 4, 4 and 3.66 per pupil. There is a noticeable 
falling off in the five upper grades. The figures show a 
wide variation from grade to grade in some of the defects. 
Of over 50,000 pupils examined in the public schools of 
Cleveland, 62.5 per cent suffered from one or more physical 
defects; and of 1,284 pupils examined in about equal 
numbers in a congested section and in the east end 



4 MENTAL HEALTH OF SCHOOL CHILD 

(where the hving conditions were more favorable), 18.5 
per cent of the former suffered from various kinds of 
defects as against 28.4 per cent of the latter. Of 156 
pupils examined in the seven grades of the school of 
observation connected with the Summer School of the 
University of Pennsylvania, 38.5 per cent had decayed 
teeth, 20.5 per cent suffered from eyestrain, 13.5 per cent 
from nasal obstruction, 5.1 per cent from defective hearing 
and enlarged tonsils, 4.5 per cent from poor nutrition and 
2 per cent from nervous exhaustion and stoop shoulders. 
It may be assumed that these children came from the 
better social ranks. A survey of a special class of 41 
Philadelphia retardates — these pupils assumedly came 
from the lower social strata — yielded 48.7 per cent of 
eye defects, 34 per cent of defective speech, 26.8 per cent 
nose and throat troubles, 19.5 per cent nervous tempera- 
ments, 17 per cent each of orthopedic defects, lack of 
motor control and hearing defects. Of the children 
examined in Jefferson City, Missouri, for eye, nose and 
throat troubles, 41 per cent were in need of glasses, while 
7.7 per cent had defective hearing, usually in one ear. 
In the rural districts of St. Louis County, 30.6 per cent 
of the 2,000 cases examined had subnormal visual acuity in 
one or both eyes, 14 per cent had less than two-thirds nor- 
mal vision and 3 per cent less than one-half normal vision 
(these figures do not include hyperopia or mild astigmat- 
ism), 7 per cent had defective hearing in either of the ears, 
somewhat less than 2 per cent could not hear a whisper with 
either ear and .9 per cent were seriously troubled with 
adenoids. From a study of twenty-five Massachusetts, 
New York and New Jersey cities Rapeer^ estimates that 
the percentages of serious defects requiring treatment 
2 Rapeeh. School Health Administration, New York, 1913, p. 226. 



INSPECTION OF SCHOOL CHILDREN 5 

among elementary pupils are as follows : dental defects, 66 
per cent; visual defects, 7 per cent; enlarged tonsils, 6 
per cent ; adenoids and nasal obstruction, 5 per cent ; mal- 
nutrition 2 per cent; anemia and enlarged glands, 1 per 
cent ; spinal curvature, .8 per cent ; strabismus, .7 per cent ; 
hearing defects and weak lungs (not tuberculosis), .5 per 
cent and nervousness, .2 per cent. (See also Chapter 
XVI.) 

School medical inspection statistics, which are now 
available from the examination of millions of pupils in all 
sections of the country, show clearly — in spite of the 
unreliability of many of the reports — that physical 
defects in children are not restricted to any clime, race, 
environment or social condition. The children in sunny 
Southern California no less than the children of the cold 
or humid North, East and West, the children of the coun- 
try no less than the children of the city, the children of 
the rich no less than the children of the poor, labor under 
various forms of physical handicap which are usually 
subject to melioration or cure. It is impossible to esti- 
mate the percentage of physically defective pupils even 
with approximate accuracy, because the standards of the 
examiners differ very widely and because some defects 
increase with age while others decrease. Any reliable 
inspection surveys must be made in relation to age. My 
own estimates, based on the study of numerous statistical 
surveys, of the percentage of grade pupils seriously 
affected with various defects are as follows : defective teeth 
(one or more cavities, serious malocclusion), from 50 to 
95 per cent ; defective vision and adenoids and nasal 
obstruction, from 5 to 20 per cent ; seriously enlarged or 
diseased tonsils, 5 to 15 per cent; curvature of the spine, 
2 to 7 per cent ; malnutrition, 1 to 6 per cent ; weak or 



6 MENTAL HEALTH OF SCHOOL CHILD 

tubercular lungs and defective hearing, 1 to 2 per cent. It 
is estimated that 12,000,000 of the pupils in the public 
schools of the country are to some extent handicapped by 
one or more physical defects. The typical American school 
child in the grades everywhere suffers more or less from 
some form of physical defectiveness. Sometimes the 
defects are so numerous and serious that the child's body is 
but a tissue of malfunctioning, misshapen, diseased or 
disordered organs. 

The defective condition of the physiques of our pupils 
must be a matter of very serious moment to all people who 
have the welfare of children at heart. The parent cannot 
fail to be concerned about conditions which cause dis- 
comfort, restlessness, pain or disease in his children. The 
school administrator and teacher must be vitally inter- 
ested in any conditions which may cause irregular attend- 
ance or impair the pedagogical efficiency of the learner. 
Likewise the city and the state, because they have made 
large investments in school plants and school parapher- 
nalia and have appropriated large sums for the support 
of teachers, have vital interests at stake which must be 
rigorously conserved. They have set children apart for 
a long term of years and have thereby denied them the 
opportunities of engaging in productive labor. This they 
have done in order to provide for the children such mental 
and bodily training as will eventually so increase their 
productive capacity as to insure them increased returns 
upon their investment of time and energy. In order to 
guarantee its own perpetuity the state demands an output 
from the schools that shall manifest a capacity for social 
and industrial efficiency, and any obstacle to the attain- 
ment of this end must be removed. The state demands, as 
of right, that it secure adequate returns upon the invest- 



INSPECTION OF SCHOOL CHILDREN 7 

ment of money and human sacrifice which it has made in 
the interest of the schools. 

But are the schools under existing conditions able to 
meet this just demand imposed upon them by the state? 
Manifestly not, for numerous investigations have shown 
that there is a veritable army of handicapped pupils in the 
schools who are unable properly to profit by the instruc- 
tion. The slow-progress pupils outnumber the accelerated 
pupils eight to ten times (the average for twenty-nine 
cities), while over one-third of all the elementary pupils 
are pedagogically retarded (see also Chapter II). A 
certain amount of this pedagogical retardation is un- 
doubtedly due to physical defectiveness. This would seem 
to be so on a priori grounds, for the body and the mind 
are indissolubly knit together. They are merely two 
aspects of the same unitary Hfe process. There can be no 
psychical activity without a correlated physical activity, 
no psychosis without a correlated neurosis. When the 
physical machine is crippled the mental mechanism cannot 
as a rule work harmoniously. Rarely, perhaps, does the 
mind reach its highest potential so long as the bodily 
organs function defectively. It is impossible by ordinary 
school processes to make defective sense organs to function 
properly. That physical defects often constitute a posi- 
tive deterrent to normal mental action and thus produce 
pedagogical retardation has been shown by various obser- 
vations and statistical and experimental studies. Those 
studies are discussed at length in Chapter XV (which 
see). 

It is true that in some investigations no marked corre- 
lation between physical defects and retardation in school 
progress has been found. This may sometimes be due to 
the fact that the dull, physically defective child has been 



8 MENTAL HEALTH OF SCHOOL CHILD 

pushed along irrespective of his merits, or to the fact 
that the progress of the whole class has been adjusted to 
meet his needs ; or the factor of age has complicated the 
question; or physical defects have been included which 
exert no influence upon neuronic and mental development. 
But it is certain that one of the causative factors of 
retardation and elimination (retardation usually results 
in elimination) is physical defectiveness. 

Not only so : the physically defective child tends to 
become the juvenile criminal. For the physically defect- 
ive, who tends to make the dullard, becomes dissatisfied 
with himself and discouraged with his school work and thus 
plays truant or permanently drops out of school. In one 
investigation over 95 per cent of truants were found to 
have physical defects. In many cases these eliminated 
physical defectives become the street vagrants or loafers ; 
and the loafers are the embryo criminals. Ninety per cent 
of criminals began their careers as truants or loafers, 
according to A. J. Pillsbury. Undoubtedly there is fre- 
quently a direct relation between physical defectiveness 
and moral perversity and youthful criminality. Much 
precocious criminahty is traceable to physiological mal- 
adjustment. 

The physical examination of school children would thus 
seem to be one of the important present-day public duties. 
It is false economy to allow the progress of whole classes 
to be impeded by the presence of pupils whose physical 
defects make it impossible for them to keep step with the 
normal procession. The mere removal of a physical 
obstruction will sometimes revolutionize the life history of 
a child, while years of mental training, with all their 
attendant strain and depression may accomplish practi- 
cally nothing for physically handicapped children. The 



INSPECTION OF SCHOOL CHILDREN 9 

first step in mental training should be the removal of those 
physical obstructions which stand in the way of the free, 
spontaneous activity of the mind. Nor is this work needed 
for the sake of the self-protection of the classroom ; society 
must assume the work for the sake of its own self-protec- 
tion. A cliild abnormal in body probably cannot remain 
normal in mind; he will tend, as has been said, to become 
morally perverse and criminal. Civilization is thus coming 
to face a new menace in the presence of rapidly multiplying 
multitudes of physically defective children in every com- 
munity. Instead of penalizing and trying to reform the 
child after he has developed his degenerate tendencies and 
committed his offense, would it not be more sane for 
society to turn right face about and remove one of the 
causes of the young child's perverse tendencies before the 
latter have become ineradicably ingrained ? This can only 
be done through the school medical clinic and dispensary. 
The day will come when the first tiling the schools will do 
for the first-day entrant will be to give him a thorough 
physical examination. 'First the natural ; afterward the 
spiritual.' 

That the American public is rapidly becoming awake to 
the necessity of providing for the inspection of physical 
defects in school children is apparent on every hand. 
Although school medical inspection started in this country 
only about nineteen years ago (Boston appointed fifty 
school physicians in the fall of 1894; Chicago followed in 
1895, New York in 1897 and Philadelphia in 1898), and 
although thirteen years ago only eight cities had estab- 
lished medical departments in the schools (but without 
the school nurse), the development has been so rapid 
during the last decade that in 1911 443 cities (or 42 per 
cent) of 1,038 cities reporting were supporting depart- 



10 MENTAL HEALTH OF SCHOOL CHILD 

ments of school medical inspection or school hygiene (but 
only 214 were providing 'physical examination by doc- 
tors') — this according to a report of the Russell Sage 
Foundation — while in 1912 nine states had mandatory 
laws and ten states had permissive laws in regard to school 
health work. Nevertheless, fully half of the cities of the 
country are either making no provisions whatsoever or 
very inadequate provisions for the routine physical exami- 
nation of school children, while the rural districts are 
doing practically nothing (Minnesota, Michigan and 
Virginia employ specialists to visit the rural schools, in 
order to instruct teachers in school and child hygiene). 
Very few school systems conduct dental and medical dis- 
pensaries for the free treatment of certified indigent chil- 
dren, while only seventy-six cities (in 1911) supported 
staffs of school nurses and eighty-nine cities employed 
school dentists. We are still lagging behind Europe, 
where the school physical examination work had its incep- 
tion (Sweden appointed school physicians for every 
secondary school in 1868, France organized departments 
of medical inspection in 1879, while Germany followed in 
1889), and where it has been organized in some countries 
as a function of the national government, notably in 
France, Germany, England, Norway, Belgium, Switzer- 
land and Sweden. In England and Wales the Education 
Act of 1907 makes school medical inspection compulsory 
and universal (even in the most remote rural districts). 
The work is conducted by 317 local educational authorities, 
who employ 943 school medical officers, and is under the 
administrative control of the Chief Medical Officer of the 
Board of Education for England and Wales. Every child 
is given a routine physical examination at the time of 
entering and leaving school (an intermediate examination 



INSPECTION OF SCHOOL CHILDREN 11 

at the age of eight will be required after April 1, 1915), 
which includes an examination of the special sense organs, 
the heart, lungs, lymphatic system, height, weight and 
personal and family history. Not only so, in 1913 the 
educational authorities had established ninety-five medical 
clinics and fifty-eight dental clinics for the free treatment 
of minor ailments and physical defects (exclusive of 
thirty-eight cHnics which provide X-ray treatment for 
ringworm). 

The campaign for the establishment of school medical 
and dental clinics in the United States must go on until the 
work has been made compulsory and universal. Not only 
so, dispensary dental and medical clinics should be estab- 
lished by schools for the free treatment of certified indi- 
gents, and nurses should be appointed for examination and 
follow-up work, for treating and instructing the affected 
pupils and for socio-hygienic service in the homes. For 
the work of diagnosis will be largely worthless unless the 
correction or mitigation of defects can be secured. More- 
over, it is not sufficient merely to mitigate or correct the 
physical defects in the clinic ; the success of the treatment 
will often depend on the subsequent physiological and 
mental habits of the cliild. The effects of the removal of 
adenoids and enlarged tonsils are often rendered nugatory 
because proper breatliing exercises are not subsequently 
followed. Since the schools (through their teachers, 
nurses and medical inspectors) are in a position to follow 
up and properly supervise the child after treatment, it 
seems desirable to treat all the minor ailments and defects 
in a school dispensary. The time must come when physical 
reclamation work will be recognized as one of the regular, 
fimdamental duties of the city and state school systems. 

Incidentally it may be pointed out that the qualitative 



12 MENTAL HEALTH OF SCHOOL CHILD 

standards of many medical inspectors must be elevated if 
our highest hopes for child betterment from this service 
are to be realized. 

But a further step must be taken in order to supple- 
ment and render effective in the highest measure the results 
of medical inspection and treatment and of pedagogical 
training. That is the psychological inspection of our 
large army of mentally exceptional school children. We 
do not know the complete status of the child when we have 
merely examined his bodily aspect by the available instru- 
ments of precision. The child possesses a mental aspect 
which needs to be just as thoroughly explored by instru- 
ments of precision. For the mental examination the 
instruments and the methods of medical inspection do not 
suffice; this work requires a technique of its own. Thus 
it is important to know how the child's motor functions 
vary, in respect to strength, steadiness, power to coordi- 
nate and speed of reaction ; how his powers of memory, 
association, imitation, adaptation, observation, attention, 
judgment, reasoning, speech, abihty to withstand fatigue, 
pressure and pain thresholds, perception of color (color 
blindness) and intellectual level vary, etc. Until such 
facts as these are known, we can have nothing but the 
most general knowledge of the child's mental constitution. 
Only by tests of this nature will it be possible to reveal 
striking departures in fundamental mental make-up ; only 
thus will it be possible to determine whether the mental 
variations in a given child are of the nature of aberrations 
or abnormalities. And only when this knowledge has been 
obtained will it be possible to make the training of a 
mentally defective or unusual child scientifically accurate, 
because the training of exceptional children must be 
adapted to the exigencies of each case ; it must be made to 



INSPECTION OF SCHOOL CHILDREN 13 

fit the special needs of every special child. In the absence 
of thorough knowledge of the child's mental peculiarities 
instruction must remain a hit-and-miss process. So far 
as the teacher is concerned, medical inspection and treat- 
ment yield knowledge of minor importance for her guid- 
ance. Medical treatment is, of course, primarily of value 
to the individual pupil. It is a means of freeing him from 
his physical impediments, so that heredity may come to 
her own. And it is, indeed, a God-send to the schools in the 
case of the child whose abnormal physical functions impede 
educational progress. Nevertheless, the psychological 
examination yields knowledge more directly valuable for 
the teacher's guidance, because her work is chiefly with the 
child's psychical functions. In the absence of any exact 
knowledge of the pecuharities of the pupil's mind her work 
must blunder along with a mixture of happy hits and 
unfortunate misses. It is not sufficient that the teacher 
adapt method to subject-matter; she must also adapt 
method to the mind which is to assimilate the subject- 
matter — the latter being the more important in the case 
of the atypical child. 

That the public is rapidly becoming awake to the neces- 
sity of segregating the atypical or special child is becom- 
ing increasingly evident. This need has been long recog- 
nized by the state so far as the idiots, imbeciles and low- 
grade morons are concerned. More recently this need has 
been recognized by about 350 cities which have established 
as an integral part of the school system so-called ungraded 
and special classes for the retarded, the seriously back- 
ward — for pupils whose mental cahber is superior to the 
feeble-minded but considerably inferior to the normal 
child — and for the feeble-minded. It is absolutely neces- 
sary that we segregate the subnormals in the public schools 



14 MENTAL HEALTH OF SCHOOL CHILD 

for at least two reasons: first, they constitute an intoler- 
able drag upon the regular classrooms, impeding their 
progress and consuming more than their just share of 
the teacher's time ; and, second, by grouping subnormals 
together in small classes they may be given individual 
attention by the teacher, and, what is more important, be 
provided with a type of school work which fits their needs 
and which will maximally equip them for the socio-indus- 
trial responsibilities which they are able to assume. 

Unfortunately the method of classifying and segre- 
gating [Subnormal children is in most cities in many 
respects pitiably inadequate. These children have almost 
invariably been segregated simply upon the classroom 
teacher's, principal's, superintendent's or medical inspec- 
tor's recommendation, because they have been unable to 
furnish the required classroom output. They have not 
been subjected to a prior thorough scientific psycho- 
educational examination, except at the hands of amateur 
psycho-clinicists. The special teacher usually gets the 
laggards without adequate diagnosis, or with mistaken 
diagnosis. Without having any precise or adequate 
knowledge of their mental and educational abnormalities, 
she is expected to give them skilled differential peda- 
gogical treatment. As a matter of fact, many special class 
teachers are simply shooting in the dark, and many 
administrators seem to feel that provided the teacher 
'keeps eternally at' the laggards she is doing all that can 
be reasonably demanded of her. 

In the light of the above facts, does it not seem the part 
of public wisdom and economy to establish in every school 
system a psycho-educational clinic for the educational and 
the psychological examination of all types of educationally 
misfit children.? Should there not be connected with every 



INSPECTION OF SCHOOL CHILDREN 15 

school system of any considerable size an expert clinical 
psychologist to supervise the examination and training of 
educationally exceptional children? 

So far as relates to the medical inspection of all school 
children, departments have been organized in the schools of 
all the large cities of the country. But it must be con- 
ceded that so far as organized psychological inspection is 
concerned we have made only a beginning, even in the 
large city systems. True, a number of schools have done 
pioneer work of great intrinsic value in this line of 
endeavor, notably the Chicago public schools, which for 
years have conducted as an integral part of the school 
system a department of Child Study and Pedagogic Inves- 
tigation. Many other city school systems are beginning 
to establish psychological clinics (see Chapter XVHI), 
but the work is usually conducted by medical inspectors or 
teachers who are profoundly ignorant of the detailed 
psychology and pedagogy of mental and educational ab- 
normalities. This is, I feel, but a temporary stage in the 
work; eventually the schools will demand the services 
of competent experts for tliis work. The fact that 
many institutions for the feeble-minded have established 
psychological clinics and are demonstrating their value 
for the proper educational classification and treatment 
of their inmates, and the fact that many universities have 
established psychological clinics not only for the examina- 
tion of cases but for the training of competent examiners, 
augur well for the rapid development of the public school 
clinic. (The Russell Sage Foundation has rendered some 
aid to the 'cause' by the compilation of retardation and 
elimination statistics, but it has done only a modicum of 
what, with its vast resources, it could be reasonably 
expected to do in the direction of establishing the normal 



16 MENTAL HEALTH OF SCHOOL CHILD 

mental norms which are so much needed for the more exact 
psychological diagnosis of mentally unusual children.) 
The school public will soon come to reahze that their duty 
toward the educationally exceptional child has not been 
discharged until, in addition to providing him with the 
advantages of medical inspection and treatment, they also 
supply the adequate machinery for determining his 
psychological and educational abnormalities. 

The first line of psycho-clinical work undertaken by the 
schools should be the expert examination of the so-called 
laggards or dullards (more properly the feeble-minded 
and seriously backward). The laggard is the one who 
creates the grave administrative problems of the schools ; 
he it is who binds a millstone about the neck of the educa- 
tional organism, who impedes the progress of the regular 
classes, who causes expensive repetition or early ehmina- 
tion; who has bottled up within his self the concentrated 
mischief of the school community ; who gives little or no 
returns for the excessive demands which he makes upon the 
teacher's time and energy. The normal child, thanks to 
his hereditary endowment, is fairly well able to fight out 
his own salvation. In him nature will assert herself even in 
the face of untoward environing circumstances. I would 
not, of course, have this type of child neglected; he ought 
to be offered every facility to work at his maximal poten- 
tial ; the normal and bright pupils are the children of 
greatest promise to the state. But as long as retarded 
children are permitted to encumber the progress of the 
regular grades we cannot do our duty by the gifted pupils. 
Our first duty, then, is the removal of the laggards from 
the regular grades: this is the 'Macedonian cry.' Any 
plan of psycho-educational inspection must first aim to 
reach the retarded children. 



INSPECTION OF SCHOOL CHILDREN 17 

As a matter of fixed school policy every child who has 
spent not more than two years in the same grade {i.e., who 
is retarded not more than one year) should be given a 
physical examination by a medical expert for the detection 
and treatment of defects of the eyes, ears, nose, throat, 
teeth, glandular system, lungs, heart, nutrition, nervous 
disorders, etc. ; and a psychological examination by a 
competent consulting psychologist for the detection of 
intellectual retardation and anomahes of sensation, move- 
ment, memory, imagination, association, attention, imita- 
tion, color perception, speech, number sense, fatigue and 
for the determination of indices of stature, weight, vitality 
and dynamometry, etc. The determination may very well, 
in each case, be restricted to the most essential tests. 
These examinations, together with the previous academic 
record and family history of the child, would determine 
whether he should remain in one of the regular classes or 
whether he should be assigned to one of the special classes 
for backward or feeble-minded children. It would also 
determine details of pedagogic treatment. A retarded 
child found mentally defective through this winnowing pro- 
cess should be compelled, by school enactment, to enter the 
special class where he can be educated with a small number 
of his hkes. The first attention which some of these chil- 
dren should receive should be medical : any physical handi- 
caps which impede the efficient activity of the mind should 
be removed before the child is compelled to undergo the 
educative processes of the schoolroom. Whether such 
treatment could by due process of law be made compulsory 
would be a matter for judicial decision. The child is com- 
pelled under the law to attend school; is it not his right, 
under a parity of reasoning, to demand that the state put 
him in such condition that he can assimilate those con- 



18 MENTAL HEALTH OF SCHOOL CHILD 

tents demanded of him by a compulsory attendance law? 
Certain it is that mere recommendation is not sufficient: 
there is a large gap between advising a parent to provide 
proper medical treatment for his child, and actually 
getting the child treated in accordance with the recom- 
mendation. Until the public is sufficiently educated on the 
question, some form of pressure must be applied. Fol- 
lowing this, however, each child should be subj ected to such 
pedagogical and mental treatment or training as the prior 
psychological and medical examinations have indicated as 
specially pertinent to his case. When a child is trans- 
ferred to a 'special' school a brief transcript of the psycho- 
logical examination, together with the examiner's recom- 
mendation, should accompany him. With tliis record in 
her possession the classroom teacher will be able to proceed 
with eyes open to a systematic and rational development of 
those functions which have become atrophied or remained 
dormant. 

In order that there be no misapprehension it should be 
stated that a large percentage of subnormal children are 
purely educational and not medical cases. Their mental 
improvement depends almost entirely upon proper peda- 
gogical training and little, if at all, upon medication or 
surgical interference. 

Under the above scheme of segregation of the feeble- 
minded and backward from the average and bright pupils, 
the psychological clinic (together with the special classes) 
would naturally become an educational clearing house. 
Some pupils sent to the special classes would eventually be 
returned to the regular classes ; others, on the contrary, 
would be sent to the feeble-minded institutions. Some of 
those who proved to be retarded because of physical defects 
would eventually catch up with their fellows after having 



INSPECTION OF SCHOOL CHILDREN 19 

received proper medical treatment and special mental 
training, and could thus be returned to the regular class- 
rooms. Likewise, many pupils merely standing in need of 
specific, corrective pedagogic treatment would be con- 
siderably improved, and often could be restored to their 
regular grades. On the other hand, those who failed to 
make any appreciable progress would thereby indicate 
that their trouble was more fundamental, a condition of 
general neural and mental arrest. Such incurably weak 
pupils should, after due training, be relegated to institu- 
tions for the feeble-minded or institutions of a similar 
nature. Their defects are an irremediable condition and 
not a disease or a specific defect amenable to curative 
treatment. Even moronic defectives can be trained to 
become self-supporting under direction only, and should be 
permanently isolated in custodial institutions where the 
conditions render it possible for them to support them- 
selves, instead of being turned adrift upon society, to 
become the victims of its vicious members and designing 
rapscalHons, or to become fresh recruits to its armies of 
vagabonds, miscreants, social delinquents and criminals. 

This rational method of selecting, treating and educat- 
ing the mentally defective or subnormal pupils must 
appeal, not only to the generous instincts aroused in any 
normal human soul by the contemplation of the sad story of 
these unfortunates, but also to our sense of business econ- 
omy and instinct of self-preservation. Society must do 
this work for its own protection. Preventive medicine, 
preventive philanthropy, preventive didactics, mental 
hygiene, are better and cheaper in the end than alms- 
houses, jails, prisons and an army of penal officers. The 
plan here advocated would yield results out of all propor- 
tion to the money expended. 



20 MENTAL HEALTH OF SCHOOL CHILD 

The psychological inspection in the city schools, to 
which I have referred, might be made a function of the 
department of psychology of training schools for teachers 
supported by municipalities,^ until the work has been 
thoroughly organized and developed in a separate division 
of the school systems. The director of the psychological 
laboratory (but only provided he possesses adequate clini- 
cal training and experience) might serve as the director 
of the psychological clinic. Three-fourths of his time 
might properly be devoted to the work of routine inspec- 
tion, and one-fourth to the work of regular classroom 
instruction in the school of education. This plan would 
render it possible to inaugurate the work with a compara- 
tively small outlay of money, as the laboratory apparatus 
could be used for a twofold purpose: instruction in the 
normal school and pupil inspection. This plan would tend 
to vitalize the instruction in psychology by bringing the 
instructor into first-hand contact with important concrete 
situations. It would give a new significance and content to 
'child study,' and afford enriched opportunities for the 
students in the 'observation courses.' What 'appHed' 
science signifies in contrast with 'pure' science, 'individual' 
psychology would come to mean in contrast with 'general' 
psychology. Individual psychology would assume a clini- 
cal significance, and become of service for mental diagnosis 
and educational guidance. 

Psychology is destined to have not only a pedagogic 
but a clinical value for education. Eventually we shall 
have an independent science of clinical psychology or 
clinical education, instruction in which w\\\ be afforded in 
all of the large progressive normal schools and colleges 

3 Schools of education under private or state control could make 
similar arrangements with public school systems. 



INSPECTION OF SCHOOL CHILDREN 21 

of education. And we shall also have psychological or 
psycho-educational clinics in the large school systems, 
manned by psychological and educational experts, for the 
purpose of classifying the educational misfits. 



CHAPTER II 

THE NEW CLINICAL PSYCHOLOGY AND THE 
PSYCHO-CLINICIST^ 

Scientific psychology is essentially a modern creation. 
It is only about a half century since the scientific methods 
of induction and experimentation were systematically 
applied to the study of mental phenomena. Yet we pos- 
sess, after this brief half century of labor, not only a 
fairly complete body of reliable theoretical psychology, 
but the promising beginnings of a number of applied 
psychologies. The methods and results of the new 
psychology have been applied, with gratifying results, 
during the last decade or two to the study of problems in 
history, literature, art, anthropology, sociology, eco- 
nomics, business, hygiene, medicine, insanity, feeble- 
mindedness, criminology, law, education and paidology. 
Its services thus far have been most valuable, perhaps, 
to education and medicine, and the outlook in these fields 
justifies the expectation that we shall soon have to christen 
various new independent sciences, namely, the sciences of 
experimental pedagogy, experimental psycho-pathology 
(with psycho- therapy) and clinical psychology (or better 
still, perhaps, psycho-educational pathology). 

In the present chapter we shall discuss one of the most 
promising of the recent applications of psychology, 
namel}'^, the new psycho-clinical movement, which has won 

1 Reprinted, with extensive alterations, from The Journal of 
Educational Psychology, 1911, pp. 121-133, and 191-210. 



NEW CLINICAL PSYCHOLOGY 23 

recognition, within a decade, in a number of universities, 
normal and medical schools, hospitals for the insane, insti- 
tutions for the feeble-minded and epileptic, reformatories 
and correctional institutions, immigration stations, juve- 
nile courts and public schools. The discussion will per- 
tain more particularly to the educational aspects of the 
movement — the psycho-clinical and psycho-educational 
examination of school children. 

1. The psychological clinic in the higher institutions 
of learning: the universities, colleges, normal schools and 
medical schools. Dr. Lightner Witmer, to whom we owe 
the name clinical psychology,^ is the pioneer psycho- 
clinician in connection with the university laboratories of 
psychology. His interest in the phenomena of mental re- 
tardation began in 1889, when his attention was drawn to 
a boy who suffered from retardation through speech defect ; 
but it was not until INIarch, 1896, that he opened the Psy- 
chological Clinic of the University of Pennsylvania and 
received his first case, a chronic bad speller (34, 35). 
Since that time Witmer's work has continued uninterrupt- 
edly and has grown apace, so that three hours daily are 
now (since 1909) devoted to the examination of children. 
These children come from homes, institutions, public and 
private schools and juvenile courts of Philadelphia and the 

2 Clinical psychology is not synonymous with medical psychology 
or psychopathology or psychiatry (see Chapters III, V and X). 
Clinical means literally bedside, and was applied originally to the 
first-hand (bedside) method of studying the individual patient. In 
psychology it designates the method of determining the mental status 
or peculiarities of an individual by a many-sided process of first- 
hand observation, testing and experiment. The clinical method may 
be used in the study of normal as well as of abnormal mentality. 
I suggest the use of the words psycho-clinical, psycho-educational 
and medico-clinical to designate, respectively, psychological, educa- 
tional and medical examinations by the clinical method. 



24 MENTAL HEALTH OF SCHOOL CHILD 

surrounding territory. Witmer's work embraces a physi- 
cal, psychological and sociological examination, in which a 
number of experts cooperate — a psychologist, neurologist, 
dentist, oculist, nose and throat speciahst and social 
worker. The social worker makes a first-hand examination 
of the child's home conditions, renders aid in the mitigation 
of bad environmental influences, and by means of 'follow- 
up work' sees that the treatment prescribed for the child 
is carried out. The clinic does not limit itself to the 
problem of diagnosis ; an orthogenic home school, or 
'hospital school,' was estabhshed in July, 1907, for the 
medical and pedagogical treatment of pay and free cases. 
This is a combined home, hospital and training school, 
where the child is provided with proper food, baths, out- 
door exercise, sleep, medical attention, discipline, motor 
training and intellectual drill in the. rudiments of the 
school fundamentals. This school also serves as a school 
of observation and a clinic for further diagnosis. Records 
of the child's hereditary, family and personal history 
(accidents, diseases, educational record, present mental 
and physical status) are preserved for reference. Courses 
in clinical psychology are offered to teachers during the 
regular and summer sessions, while classes for mentally 
exceptional children are conducted during the summer for 
purposes of training and observation. Witmer also edits 
The Psychological Clinic, now in its eighth volume, which 
is devoted to the study of the psychology, hygiene and 
education of children who are mentally and morally 
deviating. 

Within the last few years the psychological clinics have 
multiplied very rapidly. In order to obtain more accurate 
knowledge concerning the psycho-clinical work attempted, 
and the courses offered in the psychology and pedagogy of 



NEW CLINICAL PSYCHOLOGY 25 

mentally exceptional children in the colleges, universities, 
medical and normal schools in the United States, a ques- 
tionnaire was sent out in January and again in September 
and October, 1913, to the professors of psychology or 
education in all the universities and in all the larger col- 
leges, to the principals of all the state and city normal 
schools and to the deans of all the medical schools of the 
country. My thanks are due to the many respondents 
whose repHes made this study possible. The following 
were the questions asked : 

1. Do you conduct a psychological clinic for the actual 
examination of all mentally exceptional cases referred to you? 
(Date of organization, name and preparation^ of clinician, and 
equipment.) 

2. What per cent of the clinician's time is given to the 
actual clinical examination of cases ? What per cent of his 
time is given to teaching.'' To teaching branches other than 
clinical psychology and the study, care and education of 
exceptional children } 

3. Do you conduct a training clinic for training students 
in the methods of psycho-clinical and anthropometric exami- 
nation and diagnosis } 

4. What didactic courses (lectures or recitations) are 
offered in clinical psychology and the psychology and peda- 
gogy of exceptional children .'' 

5. Do you conduct training classes for exceptional chil- 
dren? If so, are they open to students for observation and 
cadet teaching? 

6. What plans are being made for the organization or 
extension of this type of work? 

Replies were received from sixty-six colleges and uni- 
versities, thirty-three state and city normal schools and 

3 The academic data are given in the subsequent pages only for 
specialists who are actually conducting psychological clinics. 



26 MENTAL HEALTH OF SCHOOL CHILD 

twenty-five medical schools. The replies are topically 
summarized under the above captions in the following 
pages. When the questions are left blank it is to be 
inferred that the answers are negative. The dates given 
refer to the time when the clinical work or courses were 
first organized. 'Hours' means the number of hours per 
week. 

Several institutions which were known to offer the type 
of work contemplated in the questionnaire failed to make 
reply, although two or three inquiries were addressed to 
them. In some of these cases data have been gathered 
from the catalogues and included in this tabulation. 

The replies are tabulated separately for the universities 
and colleges, the normal schools and the medical schools, 
in accordance with the following grouping: 

Group I comprises institutions which have established 
bona fide psychological or psycho-educational clinics ; that 
is, laboratories whose regular, primary and essential 
function is the psychological or educational examination 
of individual cases, for purposes of diagnosis and advice. 

Group II comprises institutions which either have given 
in the immediate past or which do at the present time 
give a slight amount of attention to the psychological 
testing of children with a view to arriving at individual 
mental diagnosis. These institutions can scarcely be said 
to conduct psychological clinics, although more or less 
psycho-clinical work may be attempted in the laboratories 
of psychology, education or psycho- or neuro-pathology 
(in the case of medical schools). 

Group III comprises institutions which do absolutely 
no clinical work in psychology or education (or at most 
a very negligible amount of it), but which either give 



NEW CLINICAL PSYCHOLOGY 27 

some attention to the study of mentally exceptional 
children or which are ready to develop certain lines of 
this work. 

Universities and CoiiLEGEs 
Group I 

University of Pennsylvania 
(From the catalogue, 1912-1913) 

1. 'Psychological Clinic' organized in March, 1896, in 
the department of psychology. Director, Lightner Witmer, 
Professor of Psychology (Ph.D. in psychology), assisted by 
a staff of psychologists, physicians and social workers. 

3. Yes. 

4. (1) 'Growth and Retardation' (Witmer). 

(2) 'Tests and Measurements,' 3 hours one or two terms. 

(3) 'Social Research in Clinical Psychology,' 4 hours one 
term. 

(4) 'The Exceptional Child,' 1 hour one term. 

(5) 'The Training and Treatment of Exceptional Chil- 
dren,' 1 hour one term. 

(6) 'Clinical Psychology,' 1 hour one or two terms. 

(7) 'Mental Defects,' l^/o hours one term. 

(8) 'Orthogenics,' 1% hours one term. 

5. Yes. 

Didactic and clinical courses and an observation class are 
conducted during the summer term. 

University of Washington 

1. Clinic in operation in the department of psychology 
since the fall of 1909; conducted since 1911 by the Bailey 
and Babette Gatzert Foundation for Child Welfare. A fund 
of $30,000 was given to the University in December, 1910, 
for the maintenance of a Bureau of Child Welfare in the 



28 MENTAL HEALTH OF SCHOOL CHILD 

School of Education^ whose purpose is to provide expert 
diagnosis of mentally and physically exceptional children, 
to cooperate with local authorities throughout the state in the 
establishment of psychological laboratories and special classes, 
to furnish teachers and experts for the work, and to collect 
and publish data. Director, Stevenson Smith, Assistant 
Professor of Orthogenics (Ph.D. in psychology; additional 
work in the Psychological Clinic of the University of Penn- 
sylvania and in the Vanderbilt Clinic, New York City) ; one 
assistant, two graduate student assistants and four medical 
assistants. The Director holds the appointment of psycholo- 
gist to the Public Schools and Juvenile Court, and does a 
certain amount of field work throughout the state. Rooms 
are provided in the university psychological laboratory. 

2. Seven-eighths of Director's time given to clinical exami- 
nation and instruction of children ; rest of time given to teach- 
ing. No teaching of subjects other than those pertaining to 
the clinical work. 

3. Instruction given to graduate and undergraduate stu- 
dents in psychological, anthropological and medical methods 
of diagnosis, in courses given in 4 below. 

4. (1) 'Psychology and Education of Exceptional Chil- 
dren,' in School of Education, 4 hours during one semester 
(Smith). 

(2) 'Laboratory Course in Experimental Child Study and 
Clinical Psychology,' in department of psychology, 8 hours 
(4 credits) for one semester. 

(3) 'A Graduate Course in the Education of Exceptional 
Children' (practical work in the Psychological Clinic and 
special classes in the public schools), in the School of 
Education, 4 credits (Smith). 

(4) 'A Practical Graduate Course in Clinical Methods,' in 
the Department of Psychology, 4 credits. 

All of the above given since September, 1911. 

5. Classes are conducted at the university for feeble- 



NEW CLINICAL PSYCHOLOGY 29 

minded, backward and speech-defective cases. Open to 
student observation. Partly in charge of graduate teachers. 

6. Plan to increase didactic courses at the university. 

The courses are also offered during the summer term. 

University of Minnesota 

1. 'Free Clinic in Mental Development,' organized in the 
year 1909-1910, in the department of psychology. Director, 
J. B. Miner, Professor of Psychology (Ph.D. in psychology), 
assisted by Herbert Woodrow, Instructor in Psychology 
(Ph.D. in psychology) ; by Fred Kuhlmann, Director of 
Psychological Research, Minnesota School for Feeble-Minded 
and Colony for Epileptics (Ph.D. in psychology and educa- 
tion) ; and by J. P. Sedgwick, M.D. Full laboratory equip- 
ment in special room at University. Examinations are also 
made in reserved room in City and County Court House and in 
public school buildings. 

2. One or two days a week, including work in Juvenile 
Court; work, which is divided among several men, is equivalent 
to three-fourths of the time of one man. 

3. Students attend psychological clinic; they have their 
attention directed to the simpler matters in medical diagnosis ; 
and are privileged to visit pediatric clinics and the State School 
for the Feeble-Minded at Faribault. 

4. 'Mental Retardation,' since February, 1910, 3 hours 
for one semester (Woodrow) ; given to a separate division 
during the fall of 1912 by Kuhlmann. Also includes psycho- 
clinical examinations, and lectures on the application of facts 
to delinquents, by Miner, and medical examination by 
Sedgwick. Optional to students with one year's work in 
psychology. 

5. Graduate students sometimes work with individual chil- 
dren. A class was at one time conducted for the correction of 
stuttering. 

Courses are offered by various specialists in the summer 
school. 



30 MENTAL HEALTH OF SCHOOL CHILD 

Johns Hopkins University and Phipps Psychiatric Clinic 

1. Psychological clinic established in February, 1911. 
Director, E. B. Huey,^ Lecturer on Mental Development in the 
Johns Hopkins University, and Assistant in Psychiatry in the 
Phipps Clinic of Johns Hopkins Hospital (Ph.D. in psychol- 
ogy and education; special work in institutions for the feeble- 
minded and in clinics here and abroad) ; under the general 
direction of Dr. Adolf Meyer. Several rooms available in the 
new Phipps Clinic, but no apparatus secured as yet. 

2. Six hours per week. About one-half of the Director's 
time is given to examination and treatment. 

3. No training clinic, but students in medicine and psy- 
chology assist in the testing. 

4. (1) 'Feeble-minded and Backward Children,' January, 
1911, 1 hour for one term (Huey). 

(2) 'Clinical Psychology,' in the Medical School, consisting 
of lectures and tests, 1 hour for one term (Huey). 
No courses in other than clinical work. 

5. Experimental class for defective children was to be 
established in the Baltimore schools, enrollment limited to 15, 
none under the mental age of six, under Huey's direction. 

University of Kansas 

1. Clinic established in 1911, in department of education. 
Director, A. W. Trettien, Assistant Professor of Education 
(Ph.D. in psychology and education; additional work in hos- 
pitals in Worcester). Two rooms available; use of equipment 
in Medical School. Visits to homes. Have tested inmates in 
Boys' Industrial School. 

2. Two hours, 

3. No. 

4. (1) 'Educational Pathology,' since 1910, 2 hours for 

4 Dr. Huey died December 30, 1913. No data as to what extent of 
the work in this clinic will now be devoted to psycho-educational as 
distinguished from psycho-pathological examinations. 



NEW CLINICAL PSYCHOLOGY 31 

18 weeks, with clinical work (Trettien and Prof. R. A. 
Schwegler). 

(2) 'School Hygiene,' 3 hours for 18 weeks, covers certain 
aspects of the work (Trettien). 

(3) 'Mental Measurements,' 2 hours (Schwegler). 

5. No, but have placed children under instruction and 
observation. 

6. Plan to enlarge the work, under the direction of the 
School of Education and School of Medicine. 

Leland Stanford, Jr., University. 

1. Clinic established in the year 1911-1912, in the School 
of Education. Director, Louis M. Terman, Associate Pro- 
fessor of Education (Ph.D. in psychology and education). 
Work done in the laboratory of the department of education 
and in neighboring schools. About $400 worth of materials 
for mental and physical testing. 

2. One to 5 hours per week. About one-half of the 
Director's time. 

3. No, but major students in education are afforded prac- 
tice in giving Binet and other tests. 

4. (1) 'Clinical Child Psychology,' since 1911-1912, 2 
hours throughout the year (Terman). 

(2) 'Seminary and Research Course in the Psychology and 
Pedagogy of Backward Children' (Prof. Percy E. Davidson). 

5. A class was conducted from 1910 to 1912; now con- 
ducted by the town of Palo Alto, with the aid of the university 
clinic; enrollment, 15. 

University of Missouri 

1. Clinic organized in the year 1911-1912, in the School 
of Education, by W. H. Pyle (Ph.D. in psychology). 

2. Irregular; in fall about two afternoons per week for 
two or three months. The chief duties consist in teaching 
educational psychology. 



32 MENTAL HEALTH OF SCHOOL CHILD 

3. Yes, in connection with the clinic and a course on 'The 
Scientific Testing of Method.' 

4. 'The Abnormal Child/ since fall of 1911, 1 hour (Pyle). 

5. No, but plan to conduct classes eventually. 

6. Plan to train teachers of subnormal children, and to 
develop this work in the state. 

University of Pittsburgh 

1. 'Dispensary Psycho-Educational Clinic,' established in 
March, 1912, in the School of Education. Director, J. E. W. 
Wallin, Director of Psychological Clinic and Professor of 
Clinical Psychology and Mellen Research Fellow on the Psy- 
chology of Smoke (Ph. D. in psychology, philosophy and 
education; special work in institutions for epileptics, feeble- 
minded and insane, and in medical clinics and schools). Rooms 
in temporary quarters in the School of Education. An initial 
supply of about $350 worth of equipment for psychological 
and anthropometric testing. Student assistant for record work 
on part time. Clinical examinations conducted in cities in 
Western Pennsylvania and various other states. 

2. Varies from 10 to 20 hours per week. Somewhat less 
than two-thirds of Director's time devoted to clinical work; the 
rest to teaching. One course temporarily offered in another 
department. 

3. 'Clinic Practicum,' since June, 1912, optional. Open to 
a restricted number of students who desire a practical com- 
mand of the technique of mental and anthropometric examina- 
tion methods. Designed particularly, though not exclusively, 
for capable students who seek expert preparation for research 
or clinical work. 

4. (1) 'Clinical Psychology and the Clinical Study of 
Mentally Exceptional Children,' lectures with demonstration 
clinics, since April, 1912, 2 hours for one term. Elective, but 
required in the department (Wallin). 

(2) 'The Care and Education of Feeble-minded and Back- 



NEW CLINICAL PSYCHOLOGY 33 

ward Children/ lectures, with clinics and visits to institutions, 
since April, 1912, 2 hours for two terms. Elective, but 
required in the department (Wallin). 

(3) 'Psycho-educational Pathology and Educational Thera- 
peutics,' a detailed treatment of corrective pedagogics, since 
September, 1912, 2 hours throughout the year. Elective, but 
required in the department (Wallin). 

(4) 'Social Investigation,' field work, since September, 
1913, 2 to 4 hours throughout the year, elective but advised 
(Wallin). 

(5) 'Manu-mental and Industrial Work for the Backward, 
Feeble-minded and Insane,' since April, 1913, 2 hours through- 
out the year (Prof. H. R. Kniffin and Mr. Leon Winslow). 

5. No; expect to utilize the special classes in the public 
schools for observation and cadet teaching. Have selected 
pupils for many public school classes. 

6. Plan to expand the scope of the work in various direc- 
tions. 

The didactic and clinical courses are repeated during the 
summer term, and classes of feeble-minded and backward chil- 
dren are conducted for training, observation and practical 
teaching. 

Yale University 

1. 'Juvenile Psycho-clinic,' established in April, 1912, in 
the department of education ; examinations conducted in dis- 
pensary of Medical School. Director, Arnold Gesell, Assistant 
Professor of Education (Ph.D. in psychology and education; 
additional work in the Medical School). 

2. Half of Director's time given to teaching subjects other 
than clinical psychology. 

3. OiFer a 'Clinical and Research Course for Advanced 
Students,' 1 hour; includes visits to institutions and schools. 

4. (1) 'Backward and Defective Children in the Public 
Schools,' since October, 1912, 2 hours throughout the year. 
Elective graduate course (Gesell). 



34 MENTAL HEALTH OF SCHOOL CHILD 

(2) 'Norms of Development/ scheduled 1 hour for second 
half of second term. 

5. No. 

Harvard University 

1. Clinic conducted in the out-patient department of the 
Psychopathic Hospital, Boston, since September, 1912. No 
technically trained clinical psychologist, but consultation and 
examination work is divided betvreen E. E. Southard, M.D., 
Director; R. M. Yerkes, Ph.D., psychologist; W. F. Dearborn, 
Ph.D., psycho-educationalist; Herman Adler, M.D., chief of 
staff; V. V. Anderson, M.D., and F. D. Bosworth, Jr., M.D., 
examiners. 

2. Clinics conducted by different examiners every after- 
noon except Sunday. No data as to what extent the examina- 
tions are psycho-educational. 

3. Clinical training afforded in Psychopathic Hospital. 

4. (1) 'Psychology of the Abnormal,' since 1912, summer 
session, 39 lectures, with clinics (William Healy, M.D.). 

(2) 'Mental Heredity and Eugenics,' in department of 
psychology (Yerkes). 

(3) 'Educational Psychology,' in department of education 
(Dearborn). 

(4) Aspects of Mental and Physical Development,' in 
department of education (Dearborn). 

(5) 'Psychopathology,' in department of psychology, with 
clinics, since 1913-1914 (Adler). 

6. No. 

6. Plan to perfect clinical and educational organization in 
the out-patient department of the Psychopathic Hospital. 
Certain courses are offered during the summer term. 

University of Cincinnati 

1. Clinic established September, 1912, in department of 
psychology. Director, B. B. Breese, Professor of Psychology 



NEW CLINICAL PSYCHOLOGY 35 

(Ph.D. in psychology), assisted by Mr. S. Isaacs. Use of six 
rooms in the Psychological Laboratory of the University. 

2. Three hours per week, or one-seventh of Director's time. 

3. Yes. 

4. 'Mental Measurements/ since September, 1912, 3 hours 
for 36 weeks (Breese and Isaacs). 

'Psychology of Mentally Defective Children' (seminar), 2 
hours. 

5. No; cooperate with special classes in public schools. 

Tulane University 

1. Clinic established in October, 1912, in School of Edu- 
cation of H. Sophie Newcomb Memorial College for Women. 
Director, John Madison Fletcher, Assistant Professor of 
Experimental and Clinical Psychology (Ph.D. in psychology 
and education) ; supported jointly by Tulane University and 
the New Orleans Board of Education.^ Board of Education 
contributes $1,500 annually. Clinic rooms in Psychological 
Laboratory of School of Education. Assistants comprise a 
supervisor of social investigation, a recorder and secretary, 
student assistants and an advisory medical staff. 

2. Three-fourths of Director's time given to clinical exami- 

5 The joint arrangement was terminated during the summer of 
1913, owing to the resignation of Dr. David Spence Hill* from the 
acting directorship of the School of Education. Dr. HiU is now 
director of the recently created Department of Educational Research 
in the New Orleans public schools. The department at present has 
a budget of $3,500 and during the present year is undertaking the 
following program of work: a vocational survey, the individual study 
of exceptional children and statistical studies of retardation. A 
brief lecture course is also offered to the students at the city normal 
school. A psychological laboratory is being equipped in the 
director's rooms in the city hall. 

* Hill. Notes on the Problems of Extreme Individual Differences 
in Children of the Public Schools. Department of Educational 
Research, New Orleans Public Schools, 1913. 



36 MENTAL HEALTH OF SCHOOL CHILD 

nation and teaching in the department; rest of time given to 
teaching experimental psychology. 

3. No. 

4. (1) 'The Psychology of the Abnormal Mind/ 3 hours 
for one term (Fletcher). 

(2) 'Clinical Psychology,' advanced course (Fletcher). 

(3) 'The Psychology of Retardation and Mental Defi- 
ciency' (Fletcher). 

5. No, but classes have been organized in the public 
schools. 

University of North Dakota 

1. Clinic started in September, 1913, in the department of 
psychology. Director, John W. Todd (Ph.D. in psychology, 
educational psychology and philosophy). Modest equipment. 
Aim to examine both normal and deviating children. 

2. Varies; the laboratory is regularly open from 2 to 
4 p.m., Mondays, Wednesdays and Thursdays. 

3. No. 

4. None. 

5. No. 

State University of Iowa 

1. Clinic established in department of psychology, Sep- 
tember, 1913. Director, R. H. Sylvester (Ph.D. in psychology; 
special preparation in clinical psychology). Aim to examine 
children anywhere in the state. 

2. Indefinite. 

3. Plan to conduct a training clinic. 

4. (1) 'The Backward Child,' 2 hours throughout the year 
(Sylvester). 

(2) 'Orthogenics,' 2 hours one semester (Sylvester). 

(3) 'Tests and Measurements,' 2 hours for one semester 
(Sylvester and Mabel Clare Williams). 

5. No, but expect to treat speech defectives. 
Courses are offered during: the summer term. 



NEW CLINICAL PSYCHOLOGY 37 

University of Oklahoma 

1. Clinic work conducted in conjunction with city schools 
and the state asylum for the insane, since the fall of 1913, in 
the School of Education, by W. W. Phelan, Director of the 
School of Education and Professor of Psychology and Educa- 
tion (Ph.D. in psychology). 

3. No. 

4. Seminar course, 2 hours, since September, 1913 
(Phelan). 

5. No. 

6. Plan to organize the work in the School of Education. 

Group II 

Clark University 

1. No psycho-clinic at present, but more or less clinical 
work, supplemented by a course of lectures, has been carried 
on by various men during the last four years in the department 
of psychology. 

Cornell University 

1. No, but occasional cases are referred to Educational 
Laboratory for examination, by G. M. Whipple, Ph. D., Assist- 
ant Professor of the Science and Art of Education. The 
laboratory has been examining by Binet scale and other tests 
various children in the George Junior Republic, with a view of 
determining advisability of requiring in future a prior psycho- 
logical examination of all candidates for admission. 

3. No, except as noted in 4. 

4. (1) 'Education of Exceptional Children,' since 1908, 2 
hours for one semester. Elective (Whipple). 

(2) 'Conduct of Mental Tests,' since 1908, for graduate 
and advanced students, 8 hours for one semester. Also given 
in summer session since 1912, 2^ hours daily, with examina- 
tion of cases (Whipple). 



38 MENTAL HEALTH OF SCHOOL CHILD 

School of Pedagogy, New York U niversity 

1. A psychological clinic is conducted for demonstrating 
cases in connection with the lecture course given by Henry H. 
Goddard, Director of Research, New Jersey Training School 
(Ph.D. in psychology and education). 

3. Yes, in the summer session. 

4. 'Education of Defectives/ since October, 1906, 3 hours 
on alternate Saturdays during the academic year. Also given 
during summer term (Goddard). 

5. Six special classes conducted during summer session 
1912, 15 pupils in each class. 

Numerous courses are offered during the summer term by 
various instructors. 

Girard College 

1. Boys in the school and candidates for admission have 
been examined since September, 1910, by Ralph L. Johnson, 
A.M. (University of Pennsylvania and New Jersey Training 
School). Have a laboratory with two rooms. 

2. Half of examiner's time given to examination and half 
to teaching morons. 

3. No. 

4. No didactic courses given. 

5. Conduct classes for morons. 

Group III 

Alfred University 

4. Brief discussions on mental defectives in courses in 
child study and educational psychology (Bessie L. Gambrell). 

Barnard College 

4. Occasional reference to topics in courses in experimental 
psychology (L. H. Hollingworth). 



NEW CLINICAL PSYCHOLOGY 39 

Bryn Mawr College 
1. No. 

3. No, but students visit the psychological clinic of the 
University of Pennsylvania and schools for deficient children. 

4. 'The Psychology of Defective and Unusual Children,' 
a graduate seminar throughout the year, first given in 1913- 
1914. Five months (J. H. Leuba). 

College of the City of New York 

(From the catalogue, 1913) 

4. 'Education of Backward and Defective Children,' lec- 
tures, demonstrations of tests, visits to classes (S. B. 
Heckman). 

Columbia University, Teachers College 

(From the catalogue, 1913) 

4. 'The Psychology and Education of Exceptional Chil- 
dren' (Naomi Norsworthy and E. A. Thorndike). 

'Normal Diagnosis and Anthropometry,' with demonstra- 
tions (W. H. McCastline). Didactic courses are offered 
during the summer session. 

Dartmouth College 

1. A few of the students of the department of psychology 
tested the pupils in the public schools during the fall of 1912 
by means of the Binet scale (W. B. Bingham). 

DePauw University 

4. 'Abnormal Psychology,' including some clinical work, 
formerly given. 

Mount Holyoke College 

3. No, but use is made of Whipple's Manual in course in 
Experimental Psychology (Samuel P. Hayes). 

4. Reference reading on exceptional children in course in 
Educational Psychology. 



40 MENTAL HEALTH OF SCHOOL CHILD 

Northwestern University 

4. 'Abnormal Psychology/ since 1909-1910, 3 hours for 
one semester, elective (R. H. Gault). A certain amount o£ 
time devoted to mental tests in course in Educational Psychol- 
ogy- 

6. It is possible that psycho-clinical work will be under- 
taken within a year or two by the public schools or the 
University. 

Ohio State University 

4. 'The Defective Child/ lectures, recitations and demon- 
strations, one semester, 3 credit hours (T. H. Haines). 

Ohio University, Athens 

4. Incidental reference to these topics in courses in psy- 
chology (Oscar Chrisman), and 'Educational Psychology' 
(Willis L. Gard). Expect to give a systematic course in the 
near future. 

Pennsylvania State College 

4. Occasional lectures given to students on exceptional 
children (A. Holmes). 

Princeton University 

4. Topics are referred to incidentally in course in 'Genetic 
Psychology,' since February, 1910 (Howard C. Warren). 

Rutgers College 

4. About 10 hours in all given to these subjects in courses 
in Elementary, Advanced and Educational Psychology and 
School Administration (W. T. Marvin and Alexander Inglis). 

6. Plans for future development not yet matured. 



NEW CLINICAL PSYCHOLOGY 41 

University of California 
1. No. 

4. During the summer session of 1913, the following 
courses were offered: 

'Clinical Psychology and the Teaching of Exceptional Chil- 
dren/ with demonstration clinic (F. G. Bruner, Ph.D., Clinical 
Psychologist to the Board of Education, Chicago). 

'Clinical Examination and Training of Subnormal Children' 
(Mrs. Vinnie C. Hicks). 

5. 'Training class for Subnormal Children,' open for 
observation (Mrs. Vinnie C. Hicks, Miss Nellie Goodhue and 
Miss Frances H. Ney). 

6. Plan to establish a psychological clinic, in affiliation 
with departments of education, psychology and medicine. 

University of Chicago, School of Education 

4. 'Psychopathic, Retarded and Mentally Deficient Chil- 
dren,' 4 hours for twelve weeks, given only in 1910-1911. 

University of Idaho 

4. Referred to incidentally in courses in Educational and 
Experimental Psychology (P. H. Soulen). 

University of Illinois 

1. No clinic, but apparatus is available for starting work. 
4, Three hours during one semester devoted to these topics 
in course in Educational Psychology (W. C. Bagley). 

University of Indiana 
(From the catalogue of the summer session, 1913) 

4. 'Orthogenics,' recitations and laboratory work, open to 
advance students 5 credit hours (E. E. Jones and Mr. John 
E. Evans). 

5. 'School of Orthogenics,' for diagnosis, laboratory study, 
observation and training of a 'limited number of defectives.' 



42 MENTAL HEALTH OF SCHOOL CHILD 

University of Michigan 

1. No. 

3. No, 

4. 'Education of Backward and Defective Children/ since 
July^ 1911, 2 hours for one semester (C, S. Berry). 

6. No, but a class for backward children in an affiliated 
public school is open to students for observation. 

Dr. Berry has recently been appointed consulting psycholo- 
gist to the public schools of Detroit and to the Michigan Home 
for Feeble-Minded and Epileptics, at Lapeer. Courses for the 
training of teachers will be offered at the latter institution 
during the summer of 1914. 

University of Montana 

4. 'Mental Pathology/ 2 hours for one semester; visits to 
institutions (Bolton). 

'Exceptional Children,' lectures and laboratory work, 
summer term, 1913. 

6. Will establish a clinic at the University. Director, 
Thaddeus L. Bolton, Professor of Psychology and Education 
(Ph.D. in psychology). 

Courses are offered during the summer term. 

University of Nevada 

4. Lectures on exceptional children in course in 'Child and 
Adult Psychology,' during six weeks, in Department of Psy- 
chology (George Ordahl). 

University of North Carolina 

1. Have tested suspected cases in several city school sys- 
tems and have induced Boards to provide training for special 
class teachers (H. W. Chase). 

4. Treated incidentally during regular and summer terms 
in course in Educational Psychology (Chase). 



NEW CLINICAL PSYCHOLOGY 43 

University of Oregon 

4. Three or four lectures on the subject are given in course 
in Mental Hygiene and Abnormal Psychology (Edmund S. 
Conklin). 

University of Southern California 

4. 'Education of Exceptional Children/ given since 1911- 
1912, 2 hours for one semester; visits to institutions (Howard 
L. Lunt). 

University of Tennessee 

4. Was emphasized in a course in Child Study and Adoles- 
cence given in summer session 1913 (Bird T. Baldwin). Two 
brief didactic courses will be offered during summer of 1914. 

University of Texas 

4. These topics treated only incidentally in course in 
Educational Psychology (J. C. Bell). 

Will establish a clinic in School of Education. 

University of Utah 

6. Legislature has been asked to establish a clinic in the 
Department of Psychology and provide for didactic courses. 
Thus far only a few cases have been examined (Joseph 
Peterson). 

University of Wisconsin 

6. Plans already considered to establish a Psychological 
Clinic in the Department of Education. 

William and Mary College 

4. These subjects are treated briefly in the course in Child 
Study (H. E. Bennett). 



44 MENTAL HEALTH OF SCHOOL CHILD 

State and City Normai. Schools 

Group I 

Colorado, The State Teachers College, Greeley 

1. Psychological clinic, established in 1908 in the depart- 
ment of psychology. Director, J. D. Heilman (Ph.D., special 
training in clinical psychology). Physical and mental exami- 
nations are provided. Children in the Denver schools have 
been examined once every two weeks. One room with fair 
laboratory equipment. 

2. About 5 hours. One-third of clinician's time given to 
teaching clinical subjects and two-thirds to teaching other 
subj ects. 

3. 'Psycho-clinical Practice,' elective, 2 hours, fall term 
(Heilman). 

4. 'Clinical Psychology,' since March, 1910, elective, 3 
hours throughout the term; also given to Denver teachers and 
principals (Heilman). 

Lectures on retardation and exceptional children, summer 
term, 1913, by various psychological specialists. 

5. Yes. Special classes for the feeble-minded, backward 
and dull, and for children with speech, reading, spelling and 
number defects; from 1 to 4 pupils per class, although the 
classes for the dull are larger. 

Group II 

California, Los Angeles State Normal School 

1. Since 1912 have examined a few children from the 
training school and juvenile court, and a few delinquent girls 
and feeble-minded children. Examiners : Grace M. Fernald 
(Ph.D. in psychology; special work in the Psychological Insti- 
tute of the Juvenile Court, Chicago), and C. W. Waddle 
(Ph.D. in psychology and education). Limited equipment. 
Two rooms provided for in plans for new building. 



NEW CLINICAL PSYCHOLOGY 45 

2. One or two hours per week, not programed. 

3. No; a week or two in the course in Child Study is given 
to familiarize students with the signs, and the means of dis- 
covering, physical defects, with demonstrations. A few stu- 
dents are taught to give psychological tests. 

4. Frequent reference to these topics in the courses in 
Child Study and Advanced Psychology. 

5. Some work with exceptional children done in training 
school. One or two special rooms provided for in the new 
training school. 

6. Plan to enlarge work if the legislature authorizes 
extension of course to four years. 

Michigan, Central State Normal School, Mount Pleasant 

1. Clinic conducted by Department of Psychology and 
Education for testing children in the training school. 
Examiner, E. C. Rowe (Ph.D. in psychology and education). 
Have the usual supply of apparatus. 

2. Four hours per week. 

3. No, but testing of pupils in training school is observed 
by students of the Normal Department. 

4. 'Clinical Psychology,' since January, 1911, 4 hours for 
12 weeks (Rowe). 

5. No. 

Group III 

Alabama, State Normal College, Florence 

6. It is possible that at some future date some of this work 
may be programed. 

Connecticut, State Normal Training School, Willimantic. 

5. Pupil teachers do individual work with exceptional 
children. 



46 MENTAL HEALTH OF SCHOOL CHILD 

Illinois 
Chicago Normal College 

1. No, this work is done by the department of child study 
of the public schools. 

2. No work regularly programed. 

3. Students and instructors (John T. McManis and Mabel 
R. Fernald) make a simple anthropometric and psychological 
examination of normal and exceptional children in the courses 
in education. One large room equipped with apparatus for 
psychological tests. 

5. No, we conduct classes for the deaf only in one of the 
practice schools. 

Expect to train teachers for backward children. 

State Normal University, Normal 

3. No, but students assist in physical measurements. 
Physical and mental data are entered on a card which accom- 
panies the child through the training school. 

Massachusetts 
State Normal School, North Adams 
5. A class for defectives is being established. 

State Normal School, Worcester 

4. Two special lectures and incidental reference to feeble- 
minded children, and an annual excursion to the School for the 
Feeble-Minded at Waltham, since February, 1910 (J. Mace 
Andress). 

Michigan 
Northern State Normal School, Marquette 

1. A few pupils in the training school have been tested 
since 1910 (G. C. Fracker). 

2. Nominal. 



NEW CLINICAL PSYCHOLOGY 47 

3. No, but students are afforded some training in giving 
the Binet tests. 

4. A few lectures are given on exceptional children, and on 
methods of diagnosis and treatment, in courses in Psychology 
and Principles of Education (Fracker and G. L. Brown). The 
diagnosis and treatment of physical defects are considered in 
the course in Hygiene and Sanitation. 

Western State Normal, Kalamazoo 

1. No programed work, but Binet-Simon tests are used 
and teachers are in touch with the problems. 

Minnesota 
State Normal School, Duluth 

4. Treated incidentally in courses in Psychology and 
Pedagogy. 

State Normal School, Winona 

1. No, but a few cases have been examined since 1898 
(J. P. Gaylord). 

5. Some special provision has been made for retarded 
(especially) and bright pupils. Open to observation by 
student teachers. 

6. If course is lengthened will develop work with unusual 
children. 

Nerv York City, Brooklyn Training School for Teachers 

3. Teachers in training give anthropometric and psycho- 
logical tests to pupils in the ungraded room. 

4. 'Psychology of Mental Defectives,' since November, 
1912, 5 hours for six weeks; now 60 hours (W. J. Taylor). 
Required of those teachers already conducting ungraded classes 
who may be designated by the supervisor of ungraded classes. 

5. One ungraded class, with one teacher and sixteen pupils 
(high grade imbeciles and morons). 



48 MENTAL HEALTH OF SCHOOL CHILD 

Oregon, Normal School, Monmouth 

4. About five weeks is devoted to these topics in course in 
Educational Psychology (E. S. Evenden). 

5. A flexible scheme of grading in the training school 
allows better adjustment of work to the needs of backward 
and bright pupils. 

6. Contingent on growth of school^ it is planned to oiFer 
a separate course in this work. 

Pennsylvania 

Bloomsburg State Normal School, Bloomshurg 

4. Treated incidentally in courses in General Psychology 
and Child Study. 

East Stroudsburg State Normal School, East Stroudsburg 

4. Incidental attention is given in course in Educational 
Psychology to tests of intelligence, and methods of studying 
and training exceptional children (D. W. LaRue). 

Indiana State Normal School, Indiana 

4. Brief presentation of subject of defective eyes and ears 
to senior class in Methods, since fall of 1911 (Frank Drew). 

Millersville State Normal School 

4. Incidental lectures in pedagogical courses on the Psy- 
chology of Abnormal and Subnormal Children. 

Philadelphia Normal School for Girls 

4. The mental and physical differences of children are 
studied in the course in Child Study. Students are given 
some training in giving tests, since 1910 (Grace Hamill). 



NEW CLINICAL PSYCHOLOGY 49 

Washington, State Normal School, Bellingham 

4. No, but Binet and deSanctis tests are used in a course 
in Child Study (Frank Deerwester). 

5. Special attention is given to dull, bright and peculiar 
children in the training school. 

West Virginia, Training School of Marshall College, 
Huntington 

6. Plan to develop some phases of this work in future. 

Wisconsin, State Normal School, Milwaukee 

6. Psychological Laboratory is gradually being equipped 
and some clinical work may be done next year (W. T. 
Stephens). 

Medical Schools 
Group I 
Columbia University, College of Physicians and Surgeons 

1. Clinic in psychology and psychotherapy, conducted in 
the Vanderbilt Clinic (out-patient department of the college), 
since 1908, especially for the examination of the 'exceptional 
and psychopathic child' (idiotic, imbecile and psychotic chil- 
dren are not received). Director, J. V. Haberman (M.D., 
Columbia and Berlin), and several assistants. 

2. From 9.20 to 12.00 a.m. three days a week. 

3. Yes, in connection with clinic and didactic course. 

4. 'Psychopathology and Therapy,' which includes mental 
examination methods and pedagogical treatment, since 1909, 
optional in fourth year, 2 hours during one-quarter year 
(Haberman). 

5. No. 



50 MENTAL HEALTH OF SCHOOL CHILD 

6. Hope in near future to affiliate with (a) Children's 
Courts^ for the purpose of examining the psychopathic cases ; 
and (b) the public schools, for the purpose of examining and 
treating children afflicted with abnormalities of disposition, 
the psychopathic constitutions of Ziehen (rather than the 
mentally defective and backward), who if not given timely 
treatment tend to recruit our classes of hystericals, inst'ables, 
delinquents, criminals and the insane. A very interesting 
program which, however, will not touch the psycho-educational 
problem of many educational deviates. 

Harvard Medical School 
See Harvard University, p. 34. 

Johns Hopkins Medical School 

See Johns Hopkins University and Phipps Psychiatric 
Institute, p. 30. 

Nerv York Post-Graduate Medical School and Hospital 

1. Clinic, since May, 1911; has served as clearing house 
for the New York Department of Public Charities since 
January, 1913. It is reported to be a 'part of the city system 
of caring for the feeble-minded children' at Randall's Island. 
Director, Max Schlapp, M.D., assisted by seven neurologists 
and three psychologists. Twelve clinic rooms and a 'com- 
pletely equipped laboratory.' 

2. Every day from 9.00 a.m. to 1.00 p.m. 

3. Graduates in medicine are permitted to witness the 
examinations. 

4. 'Amentia, Dementia and Exceptional Children,' daily 
(Schlapp). 

5. No, we attempt supervision of the classes in the city 
residential institution for the feeble-minded. 



NEW CLINICAL PSYCHOLOGY 51 

University of Chicago, Rush Medical College 

1. Clinic started in the fall of 1912, as part of neurological 
department. Two rooms, with psychological and neurological 
apparatus. Clinician in charge, Josephine E. Young (M.D., 
supplementary work in psychology in the University of 
Chicago and Columbia University). 'No clinical psychologist 
as such.' No data as to what percentage of the work is strictly 
psycho-educational. 

2. Two periods per week. 

3. None as yet. 

4. None. Later will give a course to medical students in 
psychological methods of examination, eugenics and the path- 
ology of the feeble-minded. 

5. Conduct a class Saturday mornings for all grades, one 
teacher. 

6. As soon as the money is available, expect to organize a 
well-equipped school, with a specially trained teacher in 
charge, assisted by cadets from the University of Chicago. 
Will also engage a field worker who will see that patients 
report at the referred medical clinics and that they receive 
proper care and attention at home. Aim to work in the school 
classes with border-line cases difficult to diagnose, and with 
small groups of low-grade children. The latter will come 
two or three times a week with their mothers, who will be 
instructed by the teachers how to care for the pupils at home. 
Ultimately hope to have a small institution where research 
can be prosecuted. 

Yale University Medical School 

1. Psychological clinic conducted by the Department of 
Education in the New Haven Dispensary, since April, 1912 
(Arnold GeseU, Ph.D.). 

3. No. 

4. None. 

5. No. 



52 MENTAL HEALTH OF SCHOOL CHILD 

Students entering the medical school without elementary 
psychology are required to take such a course in the university. 
A course on the physiology of the special senses is given in the 
psychological laboratory to second-year students (R. P. 
Angier, Ph.D.). 

Group II 

Georgetown Medical College 

1. No purely psychological clinic, but the 'Child Study 
Laboratory' in the dispensary division of the University Hos- 
pital affords opportunities for giving the Binet-Simon tests 
and an anthropometric and physical examination to children 
who are referred because they do not get along well at home 
or in school. By D. Percy Hickling, M.D., J. J. Madigan, 
M.D., and Miss Margaret Stewart (public teacher in ungraded 
schools). Surgical and medical treatment is afforded in the 
dispensary; parent or guardian is told how to apply hygienic 
treatment. 

3. Cases examined in the child-study laboratory are 
explained in clinics given to the fourth-year class. 

4. 'Psychiatry/ including facts of psychology, 60 hours 
each year, to third- and fourth-year classes (Wm. A. White, 
M.D., and Hickling). 

5. No, but cases are recommended to 'ungraded' classes, or 
sometimes mothers are instructed in home treatment and 
training. 

Two years of required work for entrance involves a certain 
amount of instruction in psychology. 

University of Michigan, State Psychopathic Hospital 

1. This hospital is available for mentally abnormal and 
insane children. 

Psychology required for entrance in the Medical School. 



NEW CLINICAL PSYCHOLOGY 53 

Group III 
Boston University School of Medicine 

4. Incidental reference in courses in Nervous and Mental 
Hygiene, 'Psycho-analysis and Psychotherapy/ since 1913- 
1914 (A. S. Boomhower-Guilbord, M.D.). 

5. No. 

Cornell University Medical College 

1. No psychological clinic, but abnormal children from 
the schools are frequently referred to out-patient clinic for 
examination and advice (C. L. Dana, M.D., and August Hoch, 
M.D.). 

Hahnemann Medical College, Chicago 

1. No, not apart from other clinical work. 
4. None. 

6. Are planning to organize didactic and clinical courses 
in a department of psychology for the study and care of 
exceptional children and all kinds of mental deviates. 

New York Homoeopathic Medical College and Flower Hospital 

1. No. 

3. No. 

4. Treated only incidentally in courses in Neurology and 
Psychiatry. 

Tufts College Medical School 

4. 'Mental Diseases,' lectures vrith eight or ten clinics at 
the Boston State Hospital, and two clinics on defective children 
at the Massachusetts School for Feeble-Minded Children, 
from January 1 to May 15 (Edward B. Lane, M.D., assisted 
by Walter E. Fernald, M.D.). 

'Psychopathology and Psychotherapeutics' (Morton Prince, 
M.D., J. J. Thomas, M.D., and A. W. Fairbanks, M.D.). 



54 MENTAL HEALTH OF SCHOOL CHILD 

University of Buffalo, Medical Department 

6. Now conduct a psychiatric clinic, and plan to open a 
psychological clinic with laboratory equipment in the dis- 
pensary for the examination of exceptional children. 

University of Wisconsin, Medical School 

1. No. 

4. A course in Psychology is given to medical students 
which includes reference to methods of psychological diagnosis 
(Joseph Jastrow). Also a course in Abnormal Psychology. 

Washington University, Medical School 

6. Plans are gradually crystallizing for the development 
of a psychological clinic. 

Results and Conclusions 

It is difficult to state unequivocally from the returns 
just how many genuine psychological clinics there are in 
the higher educational institutions of the country. The 
difficulty is due to the fact that the psychologists, educa- 
tionists and physicians do not as yet have a clear idea — a 
definite standard — as to what constitutes a psychological 
clinic. The physician tends to confuse the neurological 
clinic, and especially to identify the psychiatric or psycho- 
pathological clinic, with the psychological clinic. He 
inclines to the view that no special preparation is needed 
to conduct a psychological clinic for the examination of 
mentally exceptional school children, beyond taking the 
ordinary courses in neurology and psychopathology, 
learning how to administer a few stock tests in psychology 
and spending a few days visiting psychological clinics. 
Ninety-nine out of every hundred physicians have no tech- 



NEW CLINICAL PSYCHOLOGY 55 

nical knowledge of those branches of psychology and peda- 
gogy which bear on the teaching of educationally excep- 
tional children. As a result we are today confronted with 
an anomalous situation throughout the country ; medical 
inspectors and physicians, very few of whom have any 
special training in neurology and psychopathology and 
nearly all of whom lack technical training in education, 
are attempting to differentiate educationally exceptional 
children in the schools and to direct their educational train- 
ing. It ought to be evident to anyone who has worked in 
the neurological, psychopathological and psychological 
clinics, or who has taken serious pains to inform liimself, 
that the methods of examination employed in these three 
clinics frequently differ very widely, while the standpoint 
and aims of the examinations often have little in common. 
Owing to these confusions medical schools are incHned to 
report that they have psychological clinics when the clinics 
are really neurological or psychopathological clinics. 

Again, the psychologist or educationist is inclined to 
regard a psychological or educational laboratory — any 
room containing psychological and educational apparatus 
and test materials, and a psychologist or educationist — as 
a psychological clinic, although it ought to be evident that 
a psychological laboratory and an experimental psycholo- 
gist no more constitute a psychological clinic than do an 
anatomical laboratory and an anatomist constitute a 
medical clinic. The psychologist also seems to feel that 
he, too, is qualified to mentally examine children without 
special training in mental examination methods, and in 
case-taking and in clinical procedure. He seems to think 
that the ordinary courses in psychology and education 
prepare him for this work (most of the respondents did 
not answer the question regarding the character and 



56 MENTAL HEALTH OF SCHOOL CHILD 

extent of the special, technical training possessed by the 
director of the clinic, whether the latter was a psychologist 
or a physician). In consequence of these opinions certain 
universities report that they have a psychological clinic 
although the examiner has no special training for the 
work. In other institutions the practice obtains of 
parceling out the clinical examination work among the 
members of the departmental staff, none of whom may 
have definitely prepared for the work. The fact is that 
we have recently developed a new type of clinical work 
without the full recognition that it cannot successfully be 
done by either the physician or the psychologist without a 
definite technical preparation. The time must come when 
the work of educational diagnosis and guidance for men- 
tally and educationally exceptional children will not be 
entrusted to physicians who have no definite preparation in 
psychology and education, or to psychologists or educators 
who are wholly lacking in clinical training and experience. 
We are met with a further difficulty in attempting to 
evaluate the existing clinics : some of the clinics are devot- 
ing a bare hour or two per week to clinical work, while the 
remaining time of the chnicist is given to teaching, usually 
branches quite remote from clinical psychology and the 
education of juvenile mental deviates. With these clini- 
cists the clinical work is entirely incidental, albeit the 
laboratory may have been established as a bona fide clinic. 
It is evident that a clinic in which the actual work of 
psycho-educational examination is regarded as a mere by- 
play to teaching, to be indulged in an hour or two a week, 
cannot afford even sufficient practice to keep the clinicist 
instrumentally efficient. It is, therefore, only by a liberal 
construction that such an exercise can be called a clinic. 
Fortunately some of the laboratories in higher institutions 



NEW CLINICAL PSYCHOLOGY 57 

of learning are devoting themselves very largely if not 
exclusively to clinical work. In the University of Wash- 
ington seven-eighths of the director's time is devoted to 
the actual examination of cases ; the clinic is supplied with 
a considerable staff of assistants, and all the teaching 
courses of the director are limited to the study and educa- 
tion of exceptional children. At the University of Pitts- 
burgh about two-thirds of the director's time has thus far 
been given to the work of clinical examination and to the 
supervision of the examination and investigation of chil- 
dren, but two courses foreign to the department have 
temporarily been carried. The ideal university clinics, 
from the standpoint of the amount of time actually given 
to clinical examinations, are those of the University of 
Pennsylvania, the University of Washington, the Univer- 
sity of Minnesota (save for the division of the work among 
several experimental psychologists rather than its assign- 
ment to a duly qualified specialist), and the University of 
Pittsburgh. 

Recognizing that the definition and standards of any 
science must be more or less fluid during its early stages 
of development, it has seemed advisable to place a rather 
liberal construction on what constitutes a psychological 
clinic and this has been done in the grouping attempted 
in the above classification. Accepting this grouping as 
approximately correct we have today in the higher insti- 
tutions of learning nineteen psychological clinics in Group 
I and seven in Group II, or a total of twenty-six (exclusive 
of Girard College). 

Sixteen of the clinics are in universities. Thirteen of 
these are in Group I, namely those of the University of 
Pennsylvania, Washington, Minnesota, Kansas, Leland 
Stanford, Missouri, Pittsburgh, Yale, Cincinnati, Tulane, 



58 MENTAL HEALTH OF SCHOOL CHILD 

North Dakota, Iowa and Oklahoma. Three are in Group 
II: Clark, Cornell and New York University. Seven are 
in medical schools. Of these five are in Group I: the 
Vanderbilt Clinic of the College of Physicians and Sur- 
geons of Columbia University, the Psychopathic Hospital 
connected with the Harvard Medical School, the Phipps 
Psychiatric Institute of the Johns Hopkins Hospital and 
Medical School, New York Post-Graduate Medical School, 
Rush Medical College of the University of Chicago; and 
two are in Group II : Georgetown Medical School and the 
State Psychopathic Hospital of the University of Michi- 
gan. Three are in normal schools : one in Group I, Colo- 
rado State Teachers College ; and two in Group II : Los 
Angeles State Normal School and Mount Pleasant, Michi- 
gan, State Normal School. It is thus evident that over 
61 per cent of the psychological cHnics in the higher 
educational institutions are in the universities. 

Fourteen of the clinics are in private institutions and 
twelve in state institutions. All the clinics in the normal 
schools, one clinic in the medical schools, and exactly one- 
half of the climes in the universities (including the city 
institution in Cincinnati), are in state institutions. 

Sixteen of the clinics are in populous centers (nine 
university, six medical and one normal), as against ten in 
small cities (seven university, two normal and one medical). 
The urban centers, no doubt, offer a very much better field 
than the rural districts for the successful organization of 
psychological clinics. 

Thirteen of the clinics are in departments of education 
(including the clinics in the three normal schools), seven 
are in departments of medicine (including the Johns Hop- 
kins and Harvard Clinics) and six in departments of psy- 
chology. The clinics at the University of Washington and 



NEW CLINICAL PSYCHOLOGY 59 

Yale are supported by the department of education, al- 
though the laboratory of the former is in the department 
of psychology and of the latter in the dispensary of the 
medical school. 

It is significant that one-half of the clinics are in 
departments or schools of education. Three years ago I 
expressed the opinion that the university clinic dealing 
with mentally exceptional children (specifically the feeble- 
minded, backward, retarded, speech-defective, blind, deaf, 
precocious, word-blind, word-deaf, children with specific 
deficiencies in reading, spelHng, number work, writing) 
should preferably be located in the school or department 
of education. I am more strongly convinced than ever of 
the wisdom of that judgment. There seems to me to be 
no very convincing reason for locating the clinic in the 
college department of psychology. As well might we place 
the medical clinics in the college department of biology. 
Psychology is a science rather than an art, while the psy- 
cho-chnical examination of children is primarily an art 
(which, to be sure, presupposes a groundwork of scientific 
knowledge), just as teaching and medicine are primarily 
arts. Moreover, the aim of a clinic in the department of 
psychology cannot be other than the aim of a psycho- 
educational chnic, namely correct educational classifica- 
tion and advice regarding the corrective pedagogical 
training of the cliild. 

Similarly there is no very convincing reason why the 
psycho-educational clinic deahng with the types of men- 
tally unusual cases mentioned above (which are primarily 
educational cases and not medical) should be located in 
the medical school, unless it were placed in charge of a 
psycho-educational expert thoroughly trained to prescribe 
pedagogically for the school cases examined. To be sure. 



60 MENTAL HEALTH OF SCHOOL CHILD 

there are certain positive reasons that can be advanced for 
locating the psychological clinic in the central clinic or 
hospital of the medical school: parents customarily bring 
children who appear to be 'not right' to medical clinics ; it 
facilitates the transfer of cases coming to the psychologi- 
cal clinic which require medical care to the appropriate 
medical specialists, and, vice versa, cases coming to the 
medical clinics which require special educational care can 
be readily transferred to the psychological clinic ; it will 
foster greater harmony and cooperation between examin- 
ing physicians and examining psycho-educationists, and 
this will remove some of the misguided opposition and 
unjustified prejudice against the psychological examiner 
which now obtains in various quarters. 

On the other hand, if the clinics are located in the medi- 
cal school they will frequently, perhaps generally, be 
manned by physicians who are neither psychologists, 
educationists nor experts in the differential methods of edu- 
cating pedagogical deviates. On the whole, the best plan 
for the organization of a psycho-educational clinic in a 
university is to place it under the direction of a well- 
trained psychological and educational examiner, and to 
affiliate it with, or place it under, the joint administrative 
control of, the schools of education and medicine, or of the 
schools of education and medicine and the department of 
psychology. 

In so saying, however, I wish to voice the opinion that 
every first-class medical school ought to establish a psy- 
chological clinic in conjunction with its clinics in neurol- 
ogy, psychiatry and psychopathology, primarily for the 
more detailed psychological study of neurasthenic, psy- 
chotic, psychopathic and psycho-neurotic cases, and only 
secondarily for the study of the types of cases which appeal 



NEW CLINICAL PSYCHOLOGY 61 

primarily to the educational clinic. The director of the 
medical school psychological clinic (preferably a neurolo- 
gist or psychopathologist with extensive training in 
normal, abnormal and chnical psychology) should offer 
didactic, clinical and experimental courses (covering 
mental tests and psychological diagnosis) to all students 
specializing in psychiatry, psychopathology, psychas- 
thenics, neurology and psychotherapy. 

Not only have the medical schools of the country 
neglected adequately to provide for these and :allied 
courses for students specializing in psychopathology (our 
returns indicate that about a dozen medical schools are 
attempting a certain amount of this instruction and 
training; possibly a couple of dozen schools in this coun- 
try are offering measurably satisfactory courses) ;*' but 
until recently any student who did not have the bachelor's 
degree could graduate in any medical school in the coun- 
try without having taken a single systematic course in 
psychology — a fact which physicians themselves have 
lamented (Jones, Munro, Taylor, 17, 22, 27, 4). 'Most 
physicians are given not five minutes' training in psy- 
chology in the five years of their student life. There is 
no teacher of clinical psychology in any medical school in 
the country' (Jones). The average physician probably 
has less technical knowledge of the science of psychology 

6 See, however, the recent report of the committee of physicians and 
psychologists appointed by the American Psychological Association 
(7): 'It is apparent that students and graduates in medicine who 
incline toward practice in diseases of the mind and nervous system 
have few or no opportunities in the medical schools in this country 
to acquire a broader acquaintance with the subjects of neurology and 
psychiatry, than the clinical courses which are offered.' 'At present 
the teaching of psychiatry appears to be in an earlier stage than 
surgery was in the two- or three-year course in medicine twenty 
years ago.' 



62 MENTAL HEALTH OF SCHOOL CHILD 

than the average city grade teacher — all normal school 
graduates have been required to take at least one system- 
atic course in psychology. And yet the physician is 
expected to minister not only to the bodily but also to the 
mental well-being of his patient. Happily the situation in 
the medical schools is gradually changing for the better. 
Franz finds in his recent census that 'ten medical schools 
have already introduced, or plan to introduce next year, 
psychology into the curriculum or require it for entrance, 
and one advises students to take a course in psychology in 
the preparatory premedical years.' Moreover, of the 
sixty-eight medical deans or professors who answered the 
question, 75 per cent favored giving the medical students 
special instruction in psychology, while only 10 per cent 
gave negative and 15 per cent qualified affirmative or 
negative replies (7). 

There is, therefore, no need to hold a brief for the 
introduction of a required course in psychology for all 
the students in the premedical or medical curriculum. But 
it is well to reemphasize that the medical schools should 
make distinctly better provisions for teaching the special- 
ties in psychology for students preparing to specialize on 
mental cases. In justification of this contention it is only 
necessary to say that it is becoming generally recognized 
that the malfunctioning of mental processes may play a 
dynamic role in the production of certain nervous and 
mental disorders, and that mental factors play an impor- 
tant role in therapy (psychotherapy). The influence 
of suggestion, mental strife, latent complexes, suppressed 
wishes, morbid fears, obsessions, etc., in the causation of 
certain forms of abnormal behavior has been established 
by the researches of Freud and Jung and many of their 
followers, by the clinical observations and results of 



NEW CLINICAL PSYCHOLOGY 63 

Dubois (5) and of other medical practitioners, and by the 
net results, however distorted, exaggerated and unreliable 
most of the reports are, of healing cults of a pseudo- 
scientific character (24). 

Among the disorders which are now believed by many to 
be largely psychogenic in origin are the neuroses proper 
(neurasthenia and anxiety neuroses, both related to dis- 
ordered sexuality, according to the Freudians), the 
psycho-neuroses (classical or Freudian conversion hys- 
teria, anxiety hysteria and compulsion neuroses, all re- 
lated, so says Freud, to suppressed yearnings or wishes 
of a sexual nature), the Hghter forms of hypochondria and 
melancholia, and various disequilibrations bordering on 
insanity. Since the pathology seems to be partly or 
wholly psychogenic, the treatment of these disorders must 
be partly or wholly ideogenic. It must consist in the 
modification of the patient's abnormal stream of thought, 
his faulty associative mechanisms, his morbid emotional 
complexes and attitudes and his perverted instinctive 
reactions, by the methods of suggestion, reeducation or 
psycho-analysis. The efficacy ascribed to drugs, physical 
agencies, 'healing thoughts,' or 'absent treatment' in the 
treatment of the true psycho-neuroses probably comes 
from the force of suggestion: the innate impulsiveness or 
tendency of ideas to express themselves in appropriate 
physiological adjustments or glandular activities (the law 
of dynamogenesis). Whatever the explanation, there is 
nothing occult in scientific psychotherapy: it is a legiti- 
mate division of psychology and medicine. The successful 
operator must be, first and foremost, a skilled clinical or 
medical psychologist. He must be able to inspire con- 
fidence by his manner and by a correct diagnosis and 
prognosis, to awaken hope by emphasizing the favorable 



64 MENTAL HEALTH OF SCHOOL CHILD 

symptoms throughout the course of the treatment, to 
remove conflicting thoughts and suggest appropriate 
thoughts, to bring to the surface and to dissipate psychic 
complexes which cause mental strife, etc. Mental hygiene 
and therapy should not be left to dilettante and fakirs, as 
has been done: in psychotherapy 'the public has been left 
largely to its own devices, to become the victims of Chris- 
tian Scientists and dabblers in the occult, or misguided 
clergymen.' Various forms of mental affliction which have 
baffled medical skill have been left to untrained empirics 
and irregular practitioners, because medical curricula 
have made little provision for training physicians in the 
scientific mental therapy of psychic disorders. In conse- 
quence, we have for years been reaping a rich harvest of 
pseudo-psychotherapies. 

If now — to repeat — suggestion and psycho-analysis are 
the basal principles in the psychic treatment of the above 
varieties of mental disorders, and suggestive and psycho- 
analytic therapeutics are a legitimate branch of psy- 
chology and medicine, the conclusion follows that every 
complete medical school should make provision for instruc- 
tion and training in the science and art of psychological 
medicine. One of the divisions in the department of psy- 
chological medicine should be a laboratory of clinical psy- 
chology, in which the student may receive training in the 
psycho-clinical and psycho-laboratory methods of examin- 
ing patients. Training should be aff'orded in the methods 
used for testing specific mental deviations, for ascertaining 
the extent of the involution changes resulting from various 
dementias, and for measuring the degree of subnormaHty 
and supernormality. Practice should be given in the 
hypnotic, psycho-analytic and association-reaction meth- 
ods of mental diagnosis and treatment, possibly with 



NEW CLINICAL PSYCHOLOGY 65 

some attention to the psychomotor or galvanometric tests. 
Lectures should be given on the psychological and thera- 
peutical aspects of suggestion, psycho-analysis, hypnotism 
or any of the methods which enable us to lay bare dormant, 
unrecognized, suppressed mental complexes or conflicts, 
disorders and blockages in the associative mechanism, 
tendencies toward repetition or perseveration of test 
words, sensory and motor automatisms, dissociation phe- 
nomena, obsessions, fixed ideas, phobias and confusions, 
and which will enable us to construct a differential psy- 
chology of various psychic disorders. When the medical 
schools have given proper attention to these matters, 
psychological criteria will attain a diagnostic value which 
they do not yet possess. 

In attempting to determine how many institutions are 
conducting training clinics for preparing students to psy- 
chologically and educationally examine mentally excep- 
tional children, we are again obliged, because of the vague 
standards of what a psychological training clinic is, to 
attempt an evaluation of the existing clinics. Some insti- 
tutions offer merely didactic, demonstration or experi- 
mental courses in mental tests and regard these as training 
chnics ; some institutions have the students test and experi- 
ment upon each other and regard these exercises as train- 
ing clinics; and others open their dispensary clinics (often 
neurological or psychopathological rather than psycho- 
logical or psycho-educational) to students for observation, 
and regard these as training clinics. It is clear that a 
genuine psychological (or psycho-educational) training 
clinic must afford students training in studying actual 
cases of mental deviation by the methods of psychological 
observation, testing and experimentation ; it must afford 
training in the larger aspects of case-talcing and clinical 



66 MENTAL HEALTH OF SCHOOL CHILD 

procedure; it must have access to a large variety and an 
ample supply of clinical material; and it must provide 
instruction, supervision and guidance at the hands of an 
expert psycho-chnical (and psycho-educational) diagnos- 
tician. It is evident that a student who has been trained 
in a clinic frequented by a limited number of feeble-minded 
or backward children may be entirely ignorant of the great 
variety of perplexing cases of mentally and educationally 
exceptional children which are certain to come to the 
psychological clinic in the large urban centers. And it is 
entirely clear to my mind that no student can be gradu- 
ated from a university psycho-educational clinic as a 
thoroughly competent examiner unless he has made first- 
hand studies during an extended period of time (from two 
to four years, certainly not less than two) of a great 
variety of educationally unusual children — feeble-minded, 
border cases, backward, dull, normal, precocious, epilep- 
tic, aphasic, speech-defective, etc. 

The best provisions for training students in the art of 
psychological diagnosis are probably offered in the fol- 
lowing institutions : University of Pennsylvania, University 
of Washington and University of Pittsburgh. New York 
University offers good opportunities during the summer 
session — but the period is entirely too limited to make it 
possible to train experts. Among the other institutions 
reporting which afford students more or less opportunity 
for making observations, for conducting clinical examina- 
tions, or for making psychological tests and experiments 
are the following: the universities of Minnesota, Missouri, 
Yale, Leland Stanford, Cincinnati and Cornell ; the Col- 
lege of Physicians and Surgeons of Columbia, the Psycho- 
pathic Hospital of Harvard, the Phipps Clinic of Johns 
Hopkins, the New York Post-Graduate Medical School 



NEW CLINICAL PSYCHOLOGY 67 

and Hospital and the Georgetown Medical College ; the 
State Teachers College of Colorado, the Brooklyn Train- 
ing School, the Marquette, and Mount Pleasant, Michigan, 
State Normal Schools, the Los Angeles State Normal 
School, the Chicago Normal College and the Philadelpliia 
Normal School for Girls. 

Classes for the purpose of training subnonnal children 
and for affording opportunities for observation are con- 
ducted in the following universities : University of Penn- 
sylvania, University of Washington, University of 
Indiana, New York University (summer session), Uni- 
versity of Pittsburgh (summer session) and the Uni- 
versity of California (summer session) ; in the follow- 
ing normal schools : Brooklyn Training School, Los 
Angeles Normal School, the State Teachers College of 
Colorado and the North Adams, Mass., State Normal 
School, while special attention is given to exceptional chil- 
dren in the Winona, Minnesota, State Normal, Monmouth, 
Oregon, State Normal and the Willimantic, Conn., State 
Normal; and in Rush INledical School (one morning only 
for all grades, which is an almost negligible amount). 
Clinics in especially the following institutions are assisting 
public school systems in the diagnosis and selection of 
cases, or in the supervision of the classes, or in utilizing 
the classes for purposes of observation : the University of 
Pennsylvania, the University of Pittsburgh, Leland Stan- 
ford, the University of Cincinnati, the University of Miclii- 
gan, the University of Minnesota, the University of Iowa, 
the University of Washington, Yale, the Phipps Psy- 
chiatric Clinic and the New York Post-Graduate Medical 
School and Hospital. 

On the whole, very few of the clinics in any kind of 
higher institution of learning have at their disposal satis- 



68 MENTAL HEALTH OF SCHOOL CHILD 

factory 'special classes' in which mentally exceptional chil- 
dren can be properly trained, in which they can be studied 
under laboratory conditions and observed in a superior 
educational environment, and in which students in train- 
ing may be afforded superior opportunities for observation 
and cadet teacliing. Possibly this state of affairs does not 
invite serious criticism, for it is scarcely the function of 
departments of psychology in the universities or of medi- 
cal schools to conduct elementary classes for mentally 
unusual children. The duty of providing training for 
these children clearly rests with the public schools, and 
(although perhaps not to the same extent) with the 
observation and practice departments of colleges of edu- 
cation and normal schools. It is very desirable that 
classes for the educationally exceptional types of children 
be established in the practice schools of the latter institu- 
tions, in order that the diagnosis and training of these 
children may receive proper scientific study, in order that 
opportunities for follow-up work may be afforded, and in 
order that proper facilities may be afforded for training 
special teachers and expert examiners. But, after all, the 
colleges of education and the normal schools cannot care 
for 5 per cent of all the children who require special edu- 
cational treatment, and it is clearly the duty of the public 
schools to make adequate provisions for training 'all the 
children of all the people.' 

2. The psychological laboratory and clinic in the hos- 
pitals for the 'insane.' The psychological chnic is rapidly 
finding a place in the public and private institutions for 
the mentally diseased and the mentally defective classes. 
In the hospitals for the mentally alienated much of the 
recent work of value in psychiatry has been done by psy- 
chologists or by alienists trained in the methods and 



NEW CLINICAL PSYCHOLOGY 69 

imbued with the spirit of the new psychology. The 
pioneers in the new psychiatry are Wernicke, who, to be 
sure, recognizes the paramount importance of physical 
etiology in the consideration of mental diseases, but finds 
it inadequate for classification, and who makes the dis- 
orders of the content of consciousness primary (from liim 
we derive the concepts of psychosensory, intrapsychic and 
psychomotor disorders ; allopsychoses, somatopsychoses 
and autopsychoses ; afunctional, parafunctional and hyper- 
functional disorders) ; Ziehen, whose classification is 
thoroughly psychological (based upon the Herbartian and 
association psychology) ; Kraepelin, who employs the 
methods of psychological experimentation and the longi- 
tudinal method of analysis of the stream of consciousness 
(sequential course) for making a composite picture of the 
distinctive traits of various disease types ; and Freud, who 
has elaborated a unique method, the method of psycho- 
analysis, for purposes of diagnosis (disclosing submerged 
morbid mental complexes) and treatment, and who main- 
tains that the etiological factors in various neuroses are of 
purely psychic origin. In tliis country the psycho-bio- 
logical conception of various mental disorders has been 
ably championed by Adolf Meyer, M.D., the director of 
the recently opened Phipps Psychiatric Clinic at the Johns 
Hopkins Hospital, who has made notable contributions to 
the psychology of dementia praecox. Among other psy- 
chopathologists who are giving considerable study to the 
psychological aspects of mental disturbances may be men- 
tioned Drs. T. A. WilHams, A. A. Brill, Morton Prince, 
I. H. Coriat, Wm. A. White, Smith E. JelHfFe, Boris Sidis 
and August Hoch (the director of the Ward's Island Psy- 
chiatric Institute). Dr. Ernest Jones of the University of 
Toronto is an enthusiastic exponent of Freudian methods. 



70 MENTAL HEALTH OF SCHOOL CHILD 

Psychological laboratories, manned by trained psycholo^ 
gists, have been established in the following institutions: 
McLean Hospital, Waverly, Mass., since 1904, with F. 
Lyman Wells, Ph.D., as director; the Government Hos- 
pital for the Insane, Washington, D. C, since January 1, 
1907, with Shepherd Ivory Franz, Ph.D., as psychologist 
and scientific director; Friend's Asylum for the Insane, 
Frankford, Pa. (work temporarily suspended), and the 
New York Psychiatric Institute at Ward's Island (now 
apparently without a psychologist). Both Franz and 
Wells have published a considerable number of valuable 
experimental papers ranging over a wide field in the psy- 
chology of mental disease. The Massachusetts General 
Hospital maintains a psychologist (L. E. Emerson, 
Ph.D.), and more or less psychological research is being 
conducted at the King's Park Hospital, in New York 
State, by A. J. RosanofF, M. D., and very probably in 
numerous other hospitals for the insane and in psycho- 
patliic sanitaria. 

Many clinical examinations and investigations of the 
aHenated and psychopathic are necessarily partly psy- 
chological in nature, so that it is probable that psycho- 
logical research and psycho-cHnical examinations are 
conducted to some extent in the majority of state and 
private institutions throughout the country. 

3. The psycho-climcal laboratory in institutions for 
the feeble-minded and epileptic. The initial impulse 
toward the organization of laboratories of psychological 
research in these institutions came from Dr. A. C. Rogers, 
who, in 1898, engaged a psychologist (who later also 
qualified as physician). Dr. A. R. T. Wyhe, to devote 
about half of his time to the psychological study of the 
patients in the Minnesota School for Feeble-Minded and 



NEW CLINICAL PSYCHOLOGY 71 

Colony for Epileptics at Faribault. The fruits of Wylie's 
work, which continued for about three years, appear in a 
number of studies of the emotions, instincts, senses, 
memory, reaction time, and height and weight of the 
feeble-minded. 

The main impulse, however, toward the development of 
the work came from Superintendent E. R. Johnston of the 
New Jersey Training School for Feeble-Minded Boys and 
Girls at Vineland who, in 1906, appointed H. H. Goddard, 
Ph.D., as director of research. The work in Goddard's 
laboratory has progressed uninterruptedly during the last 
seven years, and has covered a wide range of interests in 
psychology and heredity. The laboratory at present 
commands the services of seventeen men and women includ- 
ing student assistants and heredity field workers. The 
following divisions have been organized : psychology ( with 
Mr. E. A. Doll as assistant psychologist), physiology 
(directed by A. W. Peters, M.D.,) and psychopatholgy 
(directed by W. J. Hickson, M.D.). 

The Vineland institution has also developed into a semi- 
nary of instruction. During the summer it offers training 
courses to teachers of retarded and subnormal cliildren, 
and to school medical inspectors. Beginning with the 
summer of 1914 only teachers who have already specialized 
in the study of the subnormal will be admitted to the 
teachers' courses. (Other institutions for the feeble- 
minded which recently have conducted, or are conducting, 
training classes for teachers are The Herbart Hall Insti- 
tute for Atypical Children, Plainfield, N. J. ; Rome State 
Custodial Asylum, Rome, N. Y., and Michigan Home for 
Feeble-Minded and Epileptic, Lapeer, Mich.) 

The result of the Vineland work is appearing in a num- 
ber of studies of the psychology and heredity of feeble- 



72 MENTAL HEALTH OF SCHOOL CHILD 

mindedness, including percentile growth curves of height, 
weight, vital capacity, hand dynamometry, endurance; 
mental classifications ; heredity charts and studies ; record 
forms ; translations of graded tests for developmental 
diagnosis, etc. (10, 11, 12). The psychological labora- 
tory has a fair equipment of apparatus and a well-chosen 
hbrary of technical books and periodicals, domestic and 
foreign. Tliis laboratory may be regarded as the first 
genuine laboratory of clinical psychology to be established 
at an institution for the feeble-minded, and has exerted a 
very wide influence in its special field. 

Within the last few years departments of psychological 
research have been organized in a number of institutions 
for these defectives. In the fall of 1909 a laboratory — the 
second of the sort in the country — was established in the 
Lincoln State School and Colony of Illinois, under the 
directorship of Dr. E. B. Huey (14). This laboratory is 
now in charge of Dr. Clara H. Town. In the fall of 1910 
the Faribault laboratory was reestablished with Dr. Fred 
Kuhlmann as director, and two new laboratories were 
established, one at the Iowa Institution for Feeble-Minded 
Children at Glenwood (this laboratory has been tem- 
porarily discontinued, but will probably be reopened in the 
near future), and one in the New Jersey State Village for 
Epileptics at Skillman. The latter laboratory, which was 
organized by the writer, is the pioneer psycho-clinical 
laboratory in colonies for epileptics. The work in this 
laboratory has been temporarily discontinued. In 1914 
the Michigan Home for Feeble-Minded and Epileptics 
appointed a consulting psychologist (see p. 42). 

Among the private schools for feeble-minded and back- 
ward children which are making some provisions for the 
psychological examination of their pupils may be men- 



NEW CLINICAL PSYCHOLOGY 73 

tioned the Bancroft Training School, Haddonfield, N. J. 
(E. A. Farrington, M.D., president) and Herbart Hall, 
Plainfield, N. J. (M. P. E. Groszmann, Pd.D., educational 
director). 

The latter institution is now fostered by the National 
Association for the Study and Education of Exceptional 
Children. During the summer and fall of 1913 its director 
traveled extensively throughout the far West and North- 
west, delivering addresses and organizing state associa- 
tions in affiliation with the national organization. 

Institutional positions in psychological research offer 
certain advantages. The incumbent is relieved of teaching 
duties and has ready access to an abundance of clinical 
material. He may also count on the sympathetic coopera- 
tion of the governing and administrative officers of the 
institution, for the view is now gaining acceptance that 
the functions of public hospital, custodial, training, correc- 
tional and penal institutions should not be limited to the 
care, treatment, occupational supervision and restraint of 
the inmates, but should include the scientific investigation 
of their present mental and physical status, and the condi- 
tions and causes which underlie various kinds of defective- 
ness and delinquency. Pubhc institutions should be 
laboratories of research as well as places for treatment, 
refuge, confinement and profitable employment. In order 
to be made attractive centers of scientific research, how- 
ever, the prerogatives and regulations affecting the 
research positions (in respect to the matter of stipend, 
rank, hours of service, vacations, publishing rights, per- 
sonal prerogatives, freedom from unnecessary restrictions, 
and from the absurd regulations of tyrannically inclined 
superintendents, etc.) should be made to conform with the 
rules which govern similar positions in the universities and 



74 MENTAL HEALTH OF SCHOOL CHH^D 

research institutions. Only thus will the best scientific 
talent find the field sufficiently attractive to forsake the 
scientific, cultural, library and laboratory advantages 
which the universities furnish in such rich measure. 
At the present time the universities have practically 
a monopoly on the scientific producers of the country. 
According to Cattell's statistical study of American men 
of science, 75 per cent of the 1,000 scientists of the first 
rank are located in the colleges and universities (3). 
There is an inviting virgin soil for scientific investigators 
in institutions for defectives. Pro^dded that proper in- 
ducements are offered, these institutions bid fair to become 
large productive centers of scientific work in the near 
future. 

So far as psychological work is concerned, it is pertinent 
to point out that the function of the psychologist is to 
study mind in all its manifestations and under all its con- 
ditions. The psychologist should, therefore, have the free- 
dom of the institution ; he should have ready access to the 
patients in the cottages or schoolhouse or in the field, no 
less than in the laboratory. There may be a certain arti- 
ficiahty and formality about psycho-laboratory work, a 
certain unnaturalness in the attitude or the reactions of 
the subject toward the tests. This will sometimes render 
the results one-sided or partial, and, therefore, makes it 
desirable to do supplementary work under otheif conditions. 

4. Clinical psychology in the juvenile court. The 
appHcation of the methods of clinical psychology to the 
study of the juvenile and adult offender is making rapid 
strides. The department of child study and pedagogic 
investigation of the Chicago public schools has for years 
done incidental work in this direction in connection with 
the schools for truants and delinquents. The first labora- 



NEW CLINICAL PSYCHOLOGY 75 

tory to be directly connected with a juvenile court is the 
Juvenile Psychopathic Institute, organized in Chicago 
in April, 1909, by Dr. William Healy, who secured a 
fund of $30,000 with which to defray the expenses of con- 
ducting clinical examinations of juvenile court delinquents 
for a period of five years. It was considered that five years 
was sufficiently long to demonstrate the value of the work. 
Dr. Healy, with the aid of psychological and sociological 
assistants, is engaged in the study of the underlying 
factors, physiological, psychological, social and heredi- 
tary, of juvenile criminality, and is working particularly 
with the juvenile recidivist. According to press reports 
this Institute is now supported by Cook County. 

The city of Seattle established a division of diagnosis as 
an integral part of its juvenile court in 1911, with Dr. 
Lilburn Merrill as director, and Dr. Stephenson Smith as 
consulting psychologist. In September, 1913, Dr. V. V. 
Anderson was appointed assistant probation officer of the 
municipal criminal court in Boston, for the purpose of 
making psychological and medical examinations of crimi- 
nal offenders. Various charitable agencies in many cities 
are now attempting to supply the facilities for the psycho- 
logical, medical and sociological examination of juvenile 
court cases {e.g., according to report. New York, Newark, 
Baltimore, Minneapolis, Washington, Cleveland) ; but the 
psychological examinations are often made by amateurs 
or by physicians with little or no technical training in 
psychological diagnosis, or by psychiatrists with a distinct 
psychiatric rather than psychological and educational 
bias. 

Let me, in passing, express the conviction, however, that 
the problem of the juvenile delinquent is less the problem 
of the juvenile court than the problem of the public schools. 



76 MENTAL HEALTH OF SCHOOL CHILD 

Listead of haling, a la wholesale, incipient or active child 
delinquents into court, only to parole the large majority 
of them — a procedure little calculated to impress the 
youthful offender with the gravity of his possible perver- 
sity, or with the respect due the legal statutes of the com- 
munity, or with the dignity and importance of court pro- 
cedure, and which in all events imposes a heavy tax on the 
community for the support of elaborate court machinery — 
all possible effort should be made to keep the young de- 
linquents out of court altogether. This can most success- 
fully be done by so organizing our schools that they will 
minister educationally to the peculiar needs of mentally 
and morally exceptional children. It is the public schools 
rather than the juvenile courts that should maintain in 
their educational divisions laboratories for the study and 
diagnosis of subnormal and delinquent children. Just as 
soon as the child manifests evidences of subnormality, or 
tendencies toward incorrigibility and truancy- — according 
to A. J. Pillsbury, 90 per cent of criminals began their 
criminalistic careers as truants in the schools — he should 
be examined in the psycho-educational clinic of the schools, 
which should also afford a medical, hereditary and socio- 
logical examination. As a result of the examination the 
child should be provided with appropriate physical treat- 
ment, if such is indicated ; he should be correctly classified 
psychologically and educationally, and he should be placed 
in the type of class which can provide the educational 
training which he requires. With a proper adjustment of 
the course of study to meet the needs of the individual 
delinquent the problem of juvenile delinquency largely 
solves itself. If you give abnormal children the kind of 
school work that they can do and that they Kke to do, and 
place them in a school environment that they enjoy, you 



NEW CLINICAL PSYCHOLOGY 77 

will supply the most efficient and humane system of correc- 
tives for juvenile truancy and delinquency. 

Very suggestive in this connection is the experience of 
Los Angeles (Psychological Clinic, 1913, p. 84). In the 
public schools of this city special classes for persistent 
truants (boys) were started in 1905, dedicated to the 
proposition that no pupil shall fail or be suspended or 
expelled. In these classes the boys were provided with 
adaptable men teachers and with curricula more closely 
related to the life interests of boys. The boys were given 
the type of school work which appealed to their interests, 
and was adapted to their varying capacities. In 1912 
there were nine of these classes. Among the notable 
results of this experiment are the following : 

(1) No boy was ever suspended or expelled from the 
special classes : the habit of suspending and expelling boys 
from the public schools practically ceased. 

(2) The average attendance in these classes for a 
period of seven years was 99 per cent: the fit school 
environment practically solved the non-attendance and 
truancy problems. 

(3) The truancy work of the juvenile court was prac- 
tically abolished: before the classes were organized all 
persistent truants were arrested and haled before the 
court. In 1905-1906 there were fifty-six of these cases; 
in 1906-1907, thirty; after that, never more than three a 
year, and one year none at all. Now the schools handle 
the truants, and more economically and efficiently. 

I repeat: the problem of the juvenile delinquent is pri- 
marily a problem for the schools — first, a problem of 
scientific diagnosis and, second, a problem of supplying a 
fit school environment. Juvenile courts should be courts 
of last appeal — for the persistently refractory cases and 



78 MENTAL HEALTH OF SCHOOL CHILD 

for cases which cannot be brought under the compulsory 
education laws. 

5. The psychological laboratory in penal institutions 
and correctional homes. Psychological tests (usually only 
the Binet and other simple tests by amateur psychologists) 
are now being given as a matter of daily routine to the 
boys and girls in a considerable number of reformatories 
and correctional institutions throughout the country. 

Examinations have been made since 1908 of the inmates 
(whose average age is 20.5 years) in the Massachusetts 
Reformatory for Boys at Concord, in order to determine 
their mental and moral status. These examinations have 
been made by Guy G. Femald, M.D. Physical tests are 
also employed for the purpose of selecting and segregating 
mental defectives. 

The most notable research institute in a correctional 
institution is the Laboratory of Social Hygiene in the 
New York State Reformatory for Women at Bedford 
Hills, occupying a ten-room building, equipped at a cost 
of $250,000 for the study of the causative factors and the 
best methods of training female (social) delinquents. The 
work in this laboratory began in July, 1911, under a 
$1,500 grant from the New York Foundation, but is now 
fostered by the New York Bureau of Social Hygiene. The 
director of psychological research and field work is Jean 
Weidensall, Ph.D. The staff will include a psychopatholo- 
gist, sociologist and educationist. 

The Indiana Reformatory, Jeffersonville, organized a 
department of research August 12, 1912, with Prof. 
Rufus B. von Klein Smid as director, F. C. Paschal and 
W. Beanblossom as assistants in psychology, R. W. 
Merrifield as assistant in social research and J. M. Walker, 
M.D., as consulting physician and assistant in medical 



NEW CLINICAL PSYCHOLOGY 79 

research. The cost of the psychological equipment to 
date amounts to about $500. The department administers 
the problem of the discipline of the inmates, and controls 
the disposition of their time {i.e., it determines the char- 
acter of the work suitable to each case, the character of 
the schooling to be given different boys and the transfer 
of cases to other state institutions in which they more 
properly belong). 

Among the institutions which have more recently estab- 
lished departments of psychological investigation are the 
following: Girls' Industrial Home, Sleighton Farm, Dar- 
lington, Pa. (Miss Helen F. Hill in charge since 1913), 
and the State Home for Girls at Trenton, N. J. (Mar- 
garet Otis, Ph.D., resident psychologist). Psychological 
examinations are also conducted in the Massachusetts 
Reformatory for Women at South Framingham. In 
April, 1912, the New York Probation and Protective 
Association appointed Frederick Ellis, Ph.D., to conduct 
psychological studies of the socially delinquent girls who 
are in the care of the association. 

Mention may also be made at this point of the fact that 
several states (thus New Jersey and Minnesota) have 
within the last two or three years made definite legislative 
appropriation for the study of the heredity and psychol- 
ogy of their mentally and morally abnormal dependents 
and delinquents. 

The time is near at hand when our criminals and delin- 
quents, juvenile or adult, whether in juvenile courts, jails, 
prisons, reformatories, houses of rescue or detention 
homes, will be given individual study from the points of 
view of anthropology, medicine, sociology and of clinical 
and criminal psychology. Not only so, the time must come 
when the truthfulness of testimony and the veracity of 



80 MENTAL HEALTH OF SCHOOL CHILD 

witnesses will be tested by methods other than the crude 
method of cross-examination (23). The laboratory 
method of determining capacity for correctness of descrip- 
tion and report will prove an aid to the jurist. Psychol- 
ogy is destined to contribute something toward making 
criminology and jurisprudence more scientific. When the 
methods of science have been appKed to the study of the 
delinquent and criminal, we shall be in a position to adapt 
the penalty, qualitatively as well as quantitatively, to the 
nature of the offender rather than to the nature of the 
offense. Frequently the roots of criminality lie embedded 
in a criminal neuropathic heredity, or in certain irresistible 
habits which have been engendered by vicious or criminal 
influences in the social environment, in a diseased or physi- 
cally malformed organism which thereby has become func- 
tionally maladapted to its physical and psychical environ- 
ment, or in mental deficiency. The role of the different 
causal factors must be rightly estimated for every indi- 
vidual offender before we can deal scientifically with the 
problems of crime and criminology. Our methods of crim- 
inal procedure have too long been on a par with that 
type of cure which treats effects but ignores causes. The 
Binet-Simon and other psychological tests will aid the 
ahenist and jurist in determining the mental status and 
responsibility of persons in commitment. The arrest, 
deviation or degeneration revealed by such tests will often 
be found to affect precisely those higher psychical powers 
without whose integrity of function the individual cannot 
attain that standard of conformity to law demanded by his 
social environment. It will frequently be found that the 
arrest or atrophy of various mental processes may be so 
serious as to produce permanent mental and moral 
maladjustment to the community ethical requirements. 



NEW CLINICAL PSYCHOLOGY 81 

Offenses by such individuals may be without conscious 
criminal intent. There is no immorality of intent in their 
criminal actions, though there is immorality of act. Such 
individuals are, subjectively considered, unmoral, like the 
infant who cannot appreciate the distinction between right 
and wrong. Their immorality and criminality are resolv- 
able into mental deficiency. None the less, these persons 
are a menace to society, and require permanent restraint 
as a protective, rather than a punitive, measure. 

6. The psycho-educational clinic in relation to voca- 
tional guidance. There are six essential functions of a 
vocational bureau. 

First, the maintenance of a free placement agency. 
This is the function apparently exalted above all others by 
the existing bureaus. 

Second, the making of a local vocational or industrial 
survey. This survey should include a tabulation of all the 
establishments of the community which afford employment 
to youthful wage-earners ; an appraisal of the moral, 
hygienic, sanitary and labor conditions surrounding each 
plant or type of industry; a determination of the initial 
and prospective ultimate financial returns yielded by dif- 
ferent occupations ; a determination of the chances for 
promotion together with the probable rate of advance- 
ment, and the prompt listing of positions as they become 
available. 

Third, the ascertainment of the physical health index 
and the salient anthropological indices of the applicants. 
It is unscientific and pernicious to place pupils in lines of 
employment for which they are unfitted by virtue of specific 
constitutional or acquired diatheses, diseases or defects, 
such as tubercular predisposition, gouty or rheumatic 
diatheses, neuropathic heredity, nasopharyngeal disorders. 



82 MENTAL HEALTH OF SCHOOL CHILD 

certain auditory, visual or olfactory defects, or palsies or 
deformities of certain bodily members. How many of the 
existing so-called guidance bureaus pay any consideration 
to the vital factor of bodily efficiency? Many of the 
directors of these bureaus have no technical knowledge of 
the physiological factors concerned, and apparently many 
do not seek to obtain this knowledge. 

Fourth, the ascertainment of the individual vocational 
preferences, proclivities or inclinations of the applicants. 
'Vocational guidance' which directs children into lines of 
employment for which they have no taste and in which they 
lack all interest is not only a misnomer, but it is culpable, 
inexcusable, blundering empiricism. Most children, pro- 
vided they possess the requisite psychomotor capacity, will 
succeed in any line of work in which they manifest a keen 
healthy interest. They will just as surely fail, or achieve 
an indifferent success, if they are placed in uninteresting, 
disagreeable occupations. Success in life work usually 
turns on hitching the right job to the right interest. How 
many existing bureaus make any effort to ascertain the 
real inclinations of the appKcants beyond asking a few 
perfunctory questions? How many make any effort to 
secure the independent judgment of the observant teacher 
or parent or the psychological specialist? 

Fifth, the determination of the general functional level 
of capacity or achievement — the mental or moto-industrial 
age — of the applicants. It is worse than folly to 'guide' 
children into vocations to whose efficiency demands they 
cannot adjust themselves because of all-round lack of 
mental or motor capacity. Many of the adolescent break- 
downs and adult neuroses and psychoneuroses are due to 
the inability of the persons to meet the exacting require- 
ments of the vocations in which they happen to find them- 



NEW CLINICAL PSYCHOLOGY 83 

selves. To place a child with a nine-year mentality in a 
position which requires a fourteen-year mentality is to 
condemn him to repeated failure, perennial job-hunting 
and ultimate dependency, delinquency or mental and 
nervous collapse. Many children seeking the aid of the 
bureaus will rank in capacity with the pupils who are now 
in up-to-date schools placed in the special classes for 
morons, border-line and backward cases. We know that 
most of these children will not be able to support themselves 
in trades which require any considerable degree of technical 
skill or endurance. Without attempting to review all the 
available data as to the industrial inefficiency of the gradu- 
ates of the special classes of the public schools, I may state 
that the 'Royal Commission on the Care and Control of the 
Feeble-minded' concluded that 47 per cent of the pupils 
from the special classes of the London schools will never 
be able to earn their own living, 28 per cent probably will 
do so under proper direction, while only 22 per cent may 
be regarded as 'possible wage-earners.' The 'After Care 
Committee of Birmingham' followed up the careers of 650 
graduates from the special classes of the city schools 
during nine years and found that only 18 per cent were 
doing remunerative work (at an average weekly wage of 
6s. Id.) ; a later statement (School Hygiene, February, 
1913, p. 7) indicates that 42 per cent of those reported 
were employed. Because the children were unable to retain 
their jobs, particularly as they grew older, the committee 
abandoned the free employment bureau which it conducted 
for four years. In Liverpool only 28 per cent were em- 
ployed, in Leeds 45 per cent were found in 'good promising 
or fair employment,' while the combined statistics in 1908 
from nine English cities showed that only 22 per cent were 
at work and 6.8 per cent were in irregular work. Of fifty 



84 MENTAL HEALTH OF SCHOOL CHILD 

cases selected at random from the 'ungraded classes' in 
the New York City schools only 4 per cent held permanent 
positions, 10 per cent had 'worked steadily for a few weeks 
at an average of $3.50 per week,' and the majority were 
'utterly incapable.' Of ten graduates of the subnormal 
classes in the Chicago schools who were investigated three 
were wholly unfit for responsible positions, and the average 
weekly wage of the others was only $5.73. In Germany the 
record is better — 70 to 80 per cent of the auxiliary pupils 
can earn their living, according to Bottger — ^but that is 
largely because the pupils are placed in the type of work 
that they can do, and are given supervision by guardians 
and by masters-of-trade, under whom many of them labor. 

Recently it was my fortune — or misfortune — to witness 
a director of a pubhc school bureau of vocational guidance 
'guide' a boy of fourteen into a line of work in which he 
must certainly fail. It would have been quite evident to 
a psycho-clinical specialist from a cursory examination 
that the boy was a microcephalic moron! Was it not 
essential for purposes of scientific guidance that this 
director should have known that he was negotiating with 
a feeble-minded boy who presumptively cannot stand the 
strain of skilled factory employment under the conditions 
of modern competitive industrialsm .^ What justification is 
there for calling this a guidance bureau when it makes no 
attempt to call in the consulting psychologist to determine 
the general level of functioning of at least the obviously 
abnormal cases.'' It is very clear to me that employers 
will not continue to go to school vocational bureaus for 
appHcants whose powers and capacities the bureaus have 
made no scientific attempt to evaluate. 

The present nation-wide interest in the establishment 
of bureaus of vocational guidance is commendable. But 



NEW CLINICAL PSYCHOLOGY 85 

let us not forget that many if not most of the existing 
bureaus are unconscious of any obligation to the com- 
munity except that of making vocational surveys and list- 
ing and finding jobs for work-certificate pupils. They 
are merely free employment agencies. They fall far short 
of their highest function, namely, expert scientific guid- 
ance. It would seem to be more rational and profitable to 
establish the bureaus as a division of the department of 
psycho-educational diagnosis, than as independent depart- 
ments in the public schools, so that at least the more 
ob^aous cases may be given a psychological examination 
(not to mention the anthropometric and medical) to deter- 
mine their general mental status. This should be done 
before any attempt is made to direct them into a vocation. 
To repeat : vocational guidance should include more than 
making industrial surveys: it should include the making of 
human surveys, that is, surveys of the mental (and physi- 
cal) status of the applicants themselves. Only thus shall 
we be able to find the right man for the right job and the 
right job for the right man. 

Sixth, the determination of the specific motor, mental 
or industrial gifts or deficiencies of each applicant. Suc- 
cessful workers in specific trades, handicrafts and occupa- 
tions must possess a certain minimal amount of the specific 
traits or talents, or combinations of traits, demanded by 
the occupations in question. Those who possess in maximal 
degree the required traits constitute the preferred or 
talented class of workers. It is evident, for example, that 
successful typewritists must possess a high degree of 
psychomotor rapidity and accuracy ; successful motor men 
require, for certain of their duties, a high degree of rapid- 
ity, accuracy and range of obser^'ation, of celerity of 
response and of presence of mind. It is possible experi- 



86 MENTAL HEALTH OF SCHOOL CHILD 

mentally to determine what mental capacities are required 
by successful telephone operators, ticket sellers, paper 
wrappers, railroad engineers, or any operative engaged in 
any line of skilled work whatsoever, and it is also possible 
to determine to some extent by psychological tests whether 
a given applicant for a job possesses the qualifications 
required by that job (25). However, we are better able 
with our existing diagnostic refinements to determine an 
individual's all-round grade of mental development than 
his specific vocational 'longs' or 'shorts.' 

Mention should be made in this connection of the study 
made of children who go into industry by the Schmidlapp 
Bureau and a number of private contributors, in Cincin- 
nati. The investigation includes a study of the effects of 
industrial work upon the physical and mental development 
of fourteen-year-old work-certificate children (comparative 
physical and mental measurements are made of fourteen- 
year-old children who remain in school), a study of the 
children who fail in industry (including a comparison of 
their performances in psychological tests), the establish- 
ment of age-norms for various psychological tests, and a 
study of the children's earnings, pay increases and amount 
of unemployment. The scientific work is directed by Helen 
T. Woolley, Ph.D. So far as I have been able to gather 
information no examinations have been made with a view 
to determining the general functional level or specific 
capacities of the appHcants for clinical purposes, hence 
the bureau cannot be classed as a psychological clinic, as 
some writers have done. 

7. The psychological clinic in the immigrant station. 
At the fifteenth International Congress on Hygiene and 
Demography held in Washington in September, 1912, I 



NEW CLINICAL PSYCHOLOGY 87 

took occasion to comment substantially as follows, at one 
of the sessions of the subsection on mental hygiene : 

'Recently an attempt was made to induce Congress to 
enact a law excluding immigrants on the basis of tests of 
information or literacy. The bill passed by Congress 
deserved to be vetoed, because, in my opinion, it failed 
utterly to meet the situation. What we need on the side 
of diagnosis for detecting mentally defective foreigners is 
primarily not tests of information, erudition, literacy or 
mere acquisition, but tests designed to determine the 
strength of the power of acquiring information, psycho- 
logical tests of the inherent strength of various funda- 
mental mental traits. lUiteracy and mental deficiency 
(feeble-mindedness) are not synonymous terms. Many 
illiterates come to our shores who are perfectly normal in 
mental potentials, who are capable of making the best 
citizens, intellectually, morally, socially and industrially, 
and who should, therefore, not be deported. Their illiteracy 
is due to lack of educational opportunities or proper 
mental training. The problem is to distinguish this type 
of illiteracy from the type that is due to mental sub- 
normality. Really it is not a problem of literacy or illit- 
eracy as such, but a problem of capacity and incapacity. 
It is therefore evident that what we want are not chiefly 
tests of literacy, but tests of mental capacity. If so, the 
task of diagnosing mentally defective or feeble-minded 
foreigners is distinctly a psychological problem, and 
requires the services of an expert consulting psychologist 
who has had extensive first-hand experience with feeble- 
minded cases. The average medical immigration inspector 
is just as fully "at sea" when he tries to identify the sub- 
normal immigrant as the average medical school inspector 
is "at sea" when he tries to diagnose the various types of 



88 MENTAL HEALTH OF SCHOOL CHILD 

educationally unusual children in the schools and prescribe 
appropriate orthogenic pedagogical treatment for each 
case. Neither the immigration nor the school medical 
inspectors have been specifically or professionally trained 
for these lines of highly technical and difficult work. 
Neither type of inspector would be able adequately to 
quahfy for this branch of service in less than two or three 
full years of technical training — this is especially true of 
the school medical inspector. Moreover, it may be said 
that the stock psychiatric methods of examination have 
little value except for the psychotic cases. The specialist 
on the feeble-mindedness of immigrants must receive a 
course of training which is just as specific and technical as 
that received by the specialist on the eyes, on dental sur- 
gery, on metallurgical engineering, or on kindergarten 
teaching.' 

The position thus taken has been regarded as far- 
fetched, but I believe it is essentially sound. Strong con- 
firmatory evidence that this is so is afforded by an experi- 
ment carried out during the course of one week at the 
immigrant station at Ellis Island by the psychological 
assistants from the training school for feeble-minded chil- 
dren at Vineland, N. J., the results of which have since 
appeared in print (Training School, 1913, p. 109). The 
experiment indicated that the government physicians on 
duty were able to recognize only about 10 per cent of a 
given number of the mental defectives passing through 
the port. Moreover, more than half of those whom they 
selected were incorrectly chosen, while seven-eighths of 
those selected by the Vineland workers were properly 
identified, as determined by later tests. 

Without raising the question as to the absolute relia- 
bility of the above data, there is no doubt that our immi- 



NEW CLINICAL PSYCHOLOGY 89 

grant stations, because of their defective and inadequate 
examining machinery/ are annually permitting many 
hundreds of morons and imbeciles to land upon our shores. 
These immigrants will eventually become public charges 
and, unless restrained, will produce a prolific progeny of 
social and industrial incompetents. As long as the govern- 
ment allows this situation to continue, little headway can 
be made in the effort to reduce the defective, delinquent 
and dependent classes. The way to check this national evil 
is to establish psychological clinics in the immigrant sta- 
tions, and put them in charge of thorouglily trained 
experts — either physicians or psychologists — who must 
do more than give a few psychiatric, literacy, or hap- 
hazard commonsense psychological tests. They must 
attempt a fairly comprehensive and systematic survey of 
the stage of mental development of the suspect. 

8. The psycho-educational clinic and bureau of re- 
search in the public schools. Unquestionably one of the 
most fruitful fields for the application of clinical psy- 
chology is education. Nowhere are the practical benefits to 
be derived more patent. American public schools have 
shown commendable enterprise in securing increased physi- 
cal comforts, the erection of costly material plants, the 
equipment of expensive laboratories for instruction, the 
organization of new courses to meet the enlarged demands 
of the altered social and industrial conditions of the 
twentieth century, but it must be confessed, to our shame, 
that they have lagged considerably behind the institutions 

^ Two questionnaires were addressed to the chief surgeon of one 
of the immigrant stations, with the expectation that definite, unam- 
biguous information would be obtained regarding the character of the 
psychological examinations made of subnormal immigrants, but 
without avail. A psychological clinic, however, is evidently conducted 
at the ElUs Island station. 



90 MENTAL HEALTH OF SCHOOL CHILD 

for the abnormal and defective in respect to the establish- 
ment of laboratories for discovery and research. So far 
as promoting or conducting departments for the scientific 
study of the problems which concern the normal health 
and development of the child's body and mind, the condi- 
tions under which such development can be most economi- 
cally secured, the questions of the most expeditious learn- 
ing and the most economic teaching methods, of fatigue, 
of the length of the school day and of the school year, of 
the scientific examination, and classification, segregation 
and treatment of the retarded, accelerated and delinquent, 
they have until recently done practically nothing. The 
one outstanding exception is the public schools of Chicago, 
in which a department of child study and pedagogic inves- 
tigation was established in 1899 (20). This department, 
which now commands the services of D. P. MacMillan, 
Ph.D. (director), F. G. Bruner, Ph.D., and Miss Clara 
Schmitt, has, since its organization, made various studies 
or educationally normal and misfit children — the blind, 
deaf, truant, retarded, feeble-minded, etc. — ^has regularly 
examined candidates for admission to the city normal 
school and has issued a series of valuable annual reports 
embodying its findings. 

During the last few years there has come a radical and 
gratifying change of attitude on the part of educational 
experts toward the exceptional child — the subnormal 
(idiot, imbecile, moron, border-line, backward and dull), 
the supernormal (bright, gifted, talented, precocious), 
the cripple, epileptic, speech-defective, blind, deaf and 
mute. It is now recognized by the intelligent public 
everywhere that the mentally deviating child sets a special 
problem. On a conservative estimate from 2 to 4 per cent 
of the retarded children in the schools are idiots, imbeciles, 



NEW CLINICAL PSYCHOLOGY 91 

morons, border-cases, epileptics and pronounced neurotics 
and psycho-neurotics. From 15 to 30 per cent grade all 
the way from the border-line or seriously backward cases 
to the merely dull or slow-progress pupils. Fully one- 
third (in many systems one-half) of the public school 
children are pedagogically retarded when measured by the 
age-grade standard (approximately 6,000,000 pupils in 
the United States). About 2 per cent suffer from some 
form of speech defect. There is no more vital problem in 
educational administration, constructive philanthropy or 
race conservation than the organization of intelligent 
preventive, reconstructive, educational and reeducational 
work for the large army of mentally deviating children 
which encumber our schools. To neglect properly to care 
for these children would be to invite national disaster. 
The only effective method of dealing with defective chil- 
dren is to segregate them into special groups and to pro- 
vide special treatment, care, training or restraint. Not 
only will this policy tend to remove dead weights and irri- 
tating impediments from the regular classes, so that the 
typical, hopeful, progressive children may receive their 
just dues, but in the long run it will prove the only way in 
which the mentally handicapped child can be saved to 
society from a life of idleness, pauperism or crime. He can 
be saved only by being sufficiently prepared to discharge 
the industrial and social responsibilities of citizenship or, 
in cases where special training proves unavailing because 
of grave permanent arrest or defectiveness, by being iso- 
lated from society in custodial institutions. Let us not 
forget that the first step in the successful solution of this 
vital school problem is the earli/ selection of the abnormal 
children in the scJwols by the qualified psycho-educational 
examiner. 



92 MENTAL HEALTH OF SCHOOL CHILD 

Owing to the combined influences of the laboratories of 
the Chicago schools, the University of Pennsylvania and 
Vineland, psychological tests are now being carried out in 
many public school systems throughout the country. In 
order to obtain accurate data in regard to the character 
of the work done in psychological diagnosis, as well as the 
educational provisions made for mentally unusual children 
in the public schools, a questionnaire was addressed October 
29, 1913, to the superintendents of public schools in the 
United States. The returns will be given in Chapter 
XVIII. 

At this point reference may appropriately be made to 
the state law enacted in California in 1908, authorizing 
the establishment of departments of 'health and develop- 
ment supervision' in the public schools under the control of 
boards of education or of school trustees. The program of 
work contemplates the annual physical examination of 
pupils and a 'follow-up' service, in order to correct physi- 
cal abnormalities and to provide the conditions essential 
for the maintenance of continuous health and normal 
growth; the adjustment of school activities to meet the 
developmental needs of the individual in respect to health 
and growth; the scientific, systematic study of mental 
retardation and deviation; proper sanitary supervision; 
the physical examination of candidates for teaching posi- 
tions and of teachers in service to determine their vital 
fitness and the amount of work which may reasonably be 
required of them without imperiling efficiency, and the 
appointment of expert educator-examiners to conduct and 
supervise the work. These examiners must qualify as 
experts in child hygiene and physiology. Above all, they 
should, in my judgment, be trained in the methods of 
clinical psychology and educational diagnosis. The pro- 



NEW CLINICAL PSYCHOLOGY 93 

jected California work thus rests upon a far broader 
basis than the system of medical inspection now in vogue, 
and will make it possible to grade children in health as 
well as in studies. The law is not mandatory. 

Under this law quite a number of school systems in Cali- 
fornia have established departments of health and develop- 
ment supervision (although the work done is probably 
largely restricted to the ordinary medical inspection rou- 
tine). But it is interesting to note that two of the most 
progressive school systems of the state have established 
psychological clinics independently of the department of 
health and development supervision, namely Los Angeles 
(with Mr. George L. Leslie, who was responsible for the 
'health and development law,' as director) and Oakland 
(Mrs. Vinnie C. Hicks, director). While theoretically it 
would seem desirable to locate the psychological clinic in 
the department of health and development supervision, 
practically it may be better to conduct the psycho-educa- 
tional examinations in a separate department of the 
schools, in order that the work may not be identified with 
the usual routine of medical inspection, in order that it 
may not be unduly hampered by the red tape which 
attaches to large departmental organizations, and in order 
that this important work may not be assigned a wholly 
minor role in a department whose primary interests may 
be quite foreign to the pedagogico-corrective treatment 
of mentally unusual children. 

The Possibilities of a Bureau of School Research 

In view of the fact that the intelligent educational 
public is gradually becoming reconciled to the proposition 
that the changed industrial and social conditions of modern 
life necessitate the organization of various new school 



94 MENTAL HEALTH OF SCHOOL CHILD 

agencies — departments of medical and dental inspection, 
of school hygiene, of experimental pedagogy-, of social 
survey work, of psycho-educational laboratories for the 
examination of exceptional children — I wish to pause a 
moment to outline briefly the work which a bureau of school 
research might profitably undertake for the good of the 
schools. 

At the outset it should be said that the results of the 
various agencies which are being organized in the schools 
for purposes of educational investigation and diagnosis 
are liable to run to sand unless they are properly unified, 
correlated and brought to a focus. There is need, there- 
fore, of a central, unifying bureau or department of 
school research, in charge of a director of school research, 
where the data collected by the various examining agencies 
may be gathered, preserved, compiled, compared, corre- 
lated, interpreted and turned to practical use. 

The director of such a bureau should be an expert in 
child, educational and clinical psychology, who has done 
productive work of recognized merit in these fields. He 
should be thoroughly familiar with the methods employed 
by these sciences and by experimental pedagogy, and 
should have some knowledge of medical inspection work 
(a minimum of knowledge in regard to physical diagnosis 
and the signs and symptoms of physical defectiveness and 
nervous instability). He should be a technical education- 
ist, with practical teaching experience, preferably in 
public and teacher-training schools, and must possess the 
ability to plan and direct the work along broad, progres- 
sive lines. His should be distinctly a position of leadership 
in the educational work of the schools, ranking as a direc- 
torship or assistant superintendency, and nothing but a 
thoroughly trained, broad-gauge, technical, psycho-edu- 



NEW CLINICAL PSYCHOLOGY 95 

cational consultant should be able to qualify. (Paren- 
thetically let me say that since the above was first written, 
bureaus of statistics, reference or research have been estab- 
Ushed in the public schools of New Orleans, Rochester, 
Baltimore and New York City. Cleveland also maintains a 
statistician. While these bureaus have other functions 
than those given below, the program of work in some of 
them includes statistical and clinical studies of retardation 
and the giving of efficiency tests.) 

The materials to be collected and correlated by our 
bureau should be derived from the following sources : 

1. Records and charts of physical (medical and 
dental) examinations and treatment — nasopharyngeal and 
dental charts, showing the locations of nose and throat 
obstructions and defective dentures ; vaccination records 
and charts, showing the dates of inoculation and the num- 
ber of vaccine scars ; abnormalities of the respiratory, cir- 
culatory, nutritive, muscular, osseous and nervous systems ; 
sensory defects (visual, auditory) ; records of operations 
and of medical and dental treatment, with the carefully 
determined results of such treatment, etc. The data should 
be recorded annually, if possible, on duplicate cards, which 
should accompany the child from grade to grade. The 
originals should be filed in the bureau of records. 

It would lead the discussion too far afield to consider 
what should be the detailed functions and relations of the 
department of physical or medico-dental examination. The 
matters in dispute revolve around the questions whether 
the work should be entirely confined to examination, or 
whether it should include free treatment, at least for the 
minor ailments (22) ; whether the system should be under 
the control of boards of health or of school boards ; whether 
inspection should be supplemented by follow-up educational 



96 MENTAL HEALTH OF SCHOOL CHILD 

care, treatment and supervisory work by a corps of school 
nurses, both in and out of school; whether it should em- 
brace the sanitary inspection and supervision of the 
school plant ; whether it should include instruction and 
supervision in individual and school hygiene; whether it 
should include provision for, and supervision of, school 
lunches, gratuitously available to indigent anemics, for 
school baths, gymnasia, etc. These questions cannot be 
answered in the abstract; in the near future they will 
loom large in the educational discussion of the day. They 
constitute one phase of the large eugenics or euthenics 
movement which has recently been forced into the focus 
of public attention by the threatened dangers of national 
degeneracy and racial decay of highly civilized races — 
dangers which, e.g., are evidenced in a lessened rate of 
fertility under the conditions of civihzed life (which is 
man's conscious attempt to domesticate himself) ; con- 
tinued high infant mortahty in spite of hygienic progress ; 
the enormous presence of physical defectiveness (cf. Chap- 
ters I and XVI), and the alleged prolific increase of de- 
generate or neuropathic offspring (feeble-minded, epilep- 
tic, criminal and insane). These problems cannot, in the 
face of present knowledge, be solved in any rule-of-thumb 
fashion; they must be solved according to the exigencies 
of the case and according to the results of experience. The 
ancient Spartans found it essential to their national safety 
to exercise practically unlimited supervision over the physi- 
cal, hygienic, social and educational regimen of the child, 
and they therefore removed him entirely from the family 
home. During these latter days we have been rapidly 
approximating the Spartan ideal, because recent condi- 
tions have been at work which have forced a return toward 
it. The first law of individual as well as of national life 



NEW CLINICAL PSYCHOLOGY 97 

is the law of self-preservation ; against this primal law pre- 
conceived notions and paternalistic or communistic phobias 
avail naught. The patrons of the schools demand, as of 
right, that the schools shall foster those agencies and 
practices without which they cannot realize proper divi- 
dends upon their investments, and without which the forces 
in the modem environment which are destructive of the 
public weal cannot be successfully combated. Ultimately 
all those measures must surely be introduced into the 
schools which are essentially for national self-preservation ; 
the fundamental imperative of national self-preservation 
will take precedence over all other considerations, and 
theoretical scruples will be powerless. 

There is another important question affecting medical 
school inspection which we can here merely raise: Who 
should be eligible for appointment as medical or physical 
school inspectors .f* Many of the present incumbents pos- 
sess neither technical training nor interest in the work. 
This is one reason why so much of the inspection work is 
perfunctory and thoroughly unscientific. A class of 
experts for this work scarcely yet exists, because at the 
present time there is probably not a university or medical 
school in the country that provides special, technical 
training in medical school inspection. Recently short 
courses of this character have been given by Dr. W. S. 
Cornell in the New Jersey Training School at Vineland. 
Until we secure a class of expert school health examiners — 
specialists in the neuro-physical and developmental defects 
and maladies of childhood, in school hygiene and sanita- 
tion, and in the theory and practice of dento-medical school 
inspection — appointees should be selected from the expert 
pediatricians or from the general medical practitioners 
who show a vital interest in the distinctive problems of 



98 MENTAL HEALTH OF SCHOOL CHILD 

medical school inspection. The dental work should be 
directed by a doctor of dentistry. 

2. Sociological, personal and family data. We cannot 
satisfactorily diagnose a subnormal or defective pupil by 
merely examining his present bodily conditions. There 
are other influences, hereditary, developmental and envi- 
ronmental, which have contributed to make him what he is. 
These we must understand. We must know something of 
the social organism of which he is a constituent member — 
something of his home, his community, his street life. 
The out-of-school activities and the economic, sanitary, 
hygienic, moral and intellectual conditions of the home 
and neighborhood often make or mar the individual. 
Properly to diagnose his condition we must know some- 
thing about his food and drink, about the adequacy of his 
raiment and sleep, about the purity of the air he breathes, 
about the wholesomeness of the games and amusements 
which he enjoys and the resorts which he frequents, and 
about the care and treatment which he receives in the 
home. We should obtain a record of his developTnental 
history, of his past habits, diseases, disorders and eccen- 
tricities. Particularly important are records of early 
dangerous tendencies, tantrums, fits, outbreaks or dis- 
orders or diseases which are 'prodromal' of oncoming 
adolescent or adult instabilities, neurasthenias and psy- 
chasthenias. And properly to estimate his hereditary 
dower — his inborn capital or native handicap — we must 
know something of the stock from which he springs, his 
direct and collateral antecedents. 

The two fundamental factors which make or mar the 
life of every child are heredity and environment. But it is 
impossible to determine offhand, and frequently even after 
considerable study, which of these two factors is more 



NEW CLINICAL PSYCHOLOGY 99 

largely responsible for a child's degeneracy or delinquency. 
The view that acquired degeneracy exceeds the inherited 
became rather prevalent some time ago, perhaps as a 
reaction against the Italian or Lombroso school of crimi- 
nologists who manifest an exaggerated tendency to refer 
all mental abnormalities to biological causes, and who 
maintain that there is a very prevalent degenerate (spe- 
cifically criminal) type which is born and not made. But 
recent heredity studies of feeble-mindedness, epilepsy and 
insanity show the preponderant influence of neurotic 
ancestral strains. Be this as it may, it is unquestionable 
that a vast amount of abnormal conduct is acquired from, 
or accentuated by, a bad environment ; from physically and 
morally unclean slums, from squalid or unhealthy homes, 
from vicious resorts, social vices, unhygienic school prac- 
tices and habits, etc. The first treatment which a child 
reared in the underworld needs is to be rescued: he must 
either be removed from his evil surroundings or his environ- 
ment must be reformed. This accomphshed, he must be 
supplied with proper training, food, sleep, exercise and 
clothing. Instances of children who have been transformed 
in body and mind by these measures have been frequently 
recorded ; modern 'hospital' or 'orthogenic' schools are 
demonstrating what can be done through the work of 
scientific, educational and social reclamation. 

Obviously it would be folly to aim to include in the above 
survey all the pupils of the school. At best we must be 
satisfied to include only the problematic or defective cases. 
Much valuable information can be gathered, of course, 
by teachers, principals and school nurses ; but a field 
worker, trained in social survey work, should be added to 
the staff for this particular type of service. 

3. Pedagogical records from the schools. The bureau 



100 MENTAL HEALTH OF SCHOOL CHILD 

we are advocating should also keep on file the pupil's 
school reports and records, particularly the records of the 
'problem' pupils — feeble-minded, backward, neurotic, 
truant, etc. These records, to be made out by classroom 
teachers and principals, should contain facts in regard to 
the child's age and grade (pedagogical retardation), the 
number of months he has been in school, the grades re- 
peated, the amount and type of work that he has been able 
and that he has not been able to do, his attitudes, disposi- 
tions, demeanor, behavior, dominant interests and aver- 
sions, vocational bias, regularity of attendance, etc. Such 
records will attain a unique value when studied in the light 
of the data from other sources. 

4. The results of controlled educational experiments. 
A department of experimental pedagogy should be one 
division of a complete bureau of school research. This 
department should study, under principles of scientific 
control, the important school problems in pedagogy: 
methods of teaching and learning various branches, rest 
and work periods, fatigue, recreation, the relation of 
temperature to working efficiency, the content and articu- 
lation of courses, etc. It should standardize efficiency tests 
and apply pedagogical measuring scales in the various 
branches of study. Some of the problems would be solved 
experimentally in the laboratory; others could best be 
solved by controlled school tests, and others would be 
studied in special experimental schools. The laboratory 
connected with the Chicago schools has devoted a slight 
amount of attention to problems of this character. The 
results of the pedagogical experiments should be corre- 
lated with the other data in the bureau. 

5. Psycho-clinical records from the department of 
clinical psychology. One of the most important divisions 



NEW CLINICAL PSYCHOLOGY 101 

of the bureau should be a laboratory of clinical psychology 
for the individual study of pupils, particularly subnormal, 
supernormal and delinquent children. The central aim of 
this department — we shall discuss it somewhat in detail 
presently — should be the scientific investigation of abnor- 
malities of psycho-educational development. 

Conceived in this large way, the bureau of school 
research would become a large scientific, educational clear- 
ing house, a vital agency for the scientific correlation of 
pedagogical facts and a potent instrument for the dis- 
semination of reliable educational data. It is only when 
we view the child from all angles — from the bodily, the 
psychical, the pedagogical, the sociological, the develop- 
mental and the hereditary — that we are in a position 
thoroughly to understand him, and that we are able to 
deal effectively with the problems of mental exceptionality. 

Perhaps we can best illustrate the point we wish to make 
by reference to the questions of retardation and accelera- 
tion, which are far more complex than would be supposed 
at first blush. When we are dealing with the development 
of a child we are dealing not with a single equation, but 
with a number of variable equations. Instead of one con- 
stant age, we may speak of a child as having six ages : a 
chronological, a physiological, an anatomical, a socio- 
industrial, a pedagogical and a psychological. So far as 
the chronological age is concerned, there can be no question 
of retardation ; a child born precisely fifteen years ago is 
chronologically exactly fifteen years old. But physiologi- 
cally, anatomically, pedagogically, socio-industrially and 
psychologically his development may spread over a number 
of ages. Physiologically, our fifteen-year-old child may 
be, say, only thirteen years old. Measured by the ma- 
turity of bodily functions, e.g., by the degree of pubertal 



102 MENTAL HEALTH OF SCHOOL CHILD 

or pubescent development (or size, which it is claimed, 
rouglily corresponds, 6), he has the body of a normal 
child of thirteen. He is physiologically two years re- 
tarded. Anatomically — i.e., measured by structural 
changes, particularly by the degree of ossification of the 
cartilage, Rotch's X-ray method — he may be fourteen 
years old, or only a year retarded. Measured by the 
socio-industrial or motor standard — i.e., by his rate of 
acquiring the fundamental social functions and various 
motor or industrial operations — he may be sixteen years 
old, or a year accelerated. Similarly, our fifteen-year-old 
child may be retarded 'pedagogically three years ; i.e., 
assuming that he started school on time and has arrived at 
his present grade three years later than his classmates in 
the first grade, he has a pedagogical development of 
twelve years. He is pedagogically retarded, whatever the 
cause — mental defect, physical handicap, frequent absence, 
transfer, lack of application, etc. Finally, the psychical 
age of our fifteen-year-old may be, say, only eleven ; he has 
the mental development of a child of that age. It might 
be assumed that the pedagogical and mental ages would 
coincide. At times they will, but by no means always. 
The child's pedagogical retardation may be due merely to 
late entrance, irregular attendance, frequent transfers, 
lack of interest in the particular tasks set by the school, 
or because some temporary handicap may have especially 
crippled those mental functions {e.g., memory and atten- 
tion) which play an important role in the learning 
processes of the school, in which case the pedagogical 
retardation may be greater than the mental. On the other 
hand, his pedagogical retardation may be less than his 
mental, for he may have been promoted undeservedly 
(32) ; or his abilities may have been overestimated, owing 



NEW CLINICAL PSYCHOLOGY 103 

to a heightened development of some special mental func- 
tion {e.g., memory) ; or he may have been pushed forward 
because of the pressure brought to bear on the classroom 
teacher to eliminate failures or to minimize the number of 
non-promotions. Accordingly, the child's actual mental 
development needs to be determined independently by 
serial graded age-tests, which are sufficiently compre- 
hensive to include tests of the fundamental mental func- 
tions, capacities and powers. Until recently we had no 
such tests — no measures of mental age that were regarded 
as scientifically valid. Now, thanks to the laborious and 
ingenious investigations of Binet and his co-worker, Simon, 
we have a set of graded tests which render it possible 
somewhat approximately to ascertain, in terms of age, the 
intellectual status of a child below the teens or the degree 
in which his intellectual development varies from the aver- 
age or typical child of his chronological age. While these 
tests are neither exhaustively comprehensive, 'amazingly 
accurate' nor 'infallible' — as recent experimental studies 
show (1, 12, 15, 19, 21, 28, 31) and as I shall point out 
in later pages, they give us a consistent, practical, im- 
personal, objective, scientific method of determining 
psychological retardation, which is of considerable service 
to the expert psycho-diagnostician. Standardized, graded 
intelligence tests should be given in all the large school sys- 
tems under the direction of a qualified expert. 

The Schoot. Psycho-educationai- Laboratory 

Where the establishment of a bureau of school research 
upon the comprehensive plan sketched above is not feasible, 
the most urgent need should be provided for, namely, the 
establishment of a clinical laboratory for the examination 
and grading of retarded children. 



104 MENTAL HEALTH OF SCHOOL CHILD 

I do not intend to imply that only the retarded child 
should receive the advantages of scientific diagnosis. No 
type of child has, perhaps, been so thoroughly neglected 
as the supernormal child, the child on the plus side of the 
curve of efficiency. This is probably due largely to the 
fact that 'accelerated' children are not nearly so numerous 
as retarded children, as shown by the available surveys, 
and to the fact that they do not encumber the machinery 
of the schools as do the retarded pupils. The supernormal 
or precocious child is the incipient genius ; and it is chiefly 
through the constructive achievements of its geniuses that 
civihzation advances. Both of the extreme types of the 
'special' child merit special study and treatment: the sub- 
normal child, in order that he may be relieved, so far as 
possible, of his physical and mental handicaps, so that he 
may become as little of a burden to society as possible ; and 
the supernormal child, in order that he may be surrounded 
with those conditions which, on the positive side, make for 
the freest and largest development of his potentialities, and 
which, on the negative side, will not serve to distort, abort 
or repress his natural powers. Since it is probable that 
most of the new laboratories which will be established will 
be dedicated to the study of the subnormal child, it is to 
be hoped that a laboratory will be established with the 
express and exclusive aim of studying the supernormal 
child, and that, eventually, all the large public schools will 
organize definite plans for conserving and furthering the 
interests of its incipient geniuses. Nevertheless, the enor- 
mous prevalence of retarded as compared with accelerated 
pupils makes the identification and segregation of feeble- 
minded and backward children the problem of paramount 
importance. 

In New York City there are eight slow-progress pupils 



NEW CLINICAL PSYCHOLOGY 105 

for every rapid-progress pupil ; in a Massachusetts city 
the relation was found to be 21 to 1 ; in a Pennsylvania 
city, 14 to 1 (13) ; among 8,942 graded pupils in Bureau 
County, Ilhnois, 57.5 per cent were behind the normal, 
while only 8 per cent were ahead, and among 2,090 rural 
pupils, 53.5 per cent were retarded, and only 12 per cent 
ahead; of the 137 pupils whose records were traced 
through the grades in Princeton, 111., 69.3 per cent were 
behind time, and only 4.6 per cent accelerated (8, 9) ; in 
a Baltimore class, where the progress and retardation was 
likewise traced for 43 pupils from the first to the eighth 
grade, 77 per cent arrived late, while only one arrived 
ahead of time (16) ; in three Chicago schools the per cent 
retarded was 68.1, the per cent accelerated 8.1 ; in Cin- 
cinnati (report of 1907: 26) the proportion was 58.4 per 
cent to 9.6 per cent ; in Mauch Chunk township. Pa., 34.5 
per cent to 16.6 per cent (for 842 pupils studied; most of 
the accelerated started early: 30) ; in five cities studied the 
retarded were from 10 to 150 times as numerous, and in 29 
other cities from 8 to 10 times as numerous (Ayres). It 
has been said that three out of every four must do one 
room twice, and statistics show that from 33 to 50 per cent 
of the pupils in the schools are over age for their grade. 

In the light of these statistics — and I have given a mere 
hint of the available data — it becomes imperative to under- 
take a thorough study of the extent, causes, results and 
treatment of retardation — the great threatening colossus 
of the modern school. It is particularly important to 
make psycho-educational examinations to determine the 
degree of the mental deficit of the retardate, to determine 
whether the retardation is a case of inherent deficiency or 
subnormal mental development, or whether it is the result 
of adventitious factors, such as late entrance, transfer, 



106 MENTAL HEALTH OF SCHOOL CHILD 

irregularity of attendance, illness, physical defectiveness, 
language deficiency, home abuse, poor teaching, lack of 
individual tuition, maladapted courses, indifference, etc. 
Until the schools make greater efforts to discover the 
cause of the lack of progress of the individual retardate, 
the orthogenic treatment cannot be made scientifically 
accurate or practically effective. It is the worst sort of 
possible economy to attempt to train subnormal children 
without a prior scientific educational diagnosis. 

The Specific Functions of the School's Psycho- 
educational, Laboratoey 

1. The clinical exaimnation of exceptional children. 
Every child retarded pedagogically over one year should 
be given a special preliminary medical examination, 
and then referred to the laboratory for a psycho-educa- 
tional examination. The tests should, where possible, 
include graded serial tests for determining mental age, 
form-board tests, sensory-motor tests, which have a diag- 
nostic value (auditory and visual acuity, motor skill, co- 
ordination, hand dynamometry, endurance, body sway) ; 
selected standardized tests of fundamental intellectual 
traits (memory, spontaneous and controlled association, 
accuracy and quickness of perception and observation, 
recognition, linguistic construction, learning capacity) ; 
speech tests, certain physical and anthropometric growth 
measures (sitting and standing height, weight, thoracic 
perimeter, spirometry, head circumference, together with 
vital, ponderal and statural indices, and perhaps tests of 
anatomical age), and certain reflex action tests. In 
selected cases the psycho-analytic (Freud) and reaction- 
association (Jung) tests may be relevant for purposes of 



NEW CLINICAL PSYCHOLOGY 107 

diagnosis of more fundamental or obscure mental abnor- 
malities. Anthropometric percentile curves and indices 
should be plotted for each child, showing his status relative 
to the normal child of the same chronological, and perhaps 
also anatomical and psychological age. To plot such 
curves we stand in need of reliable norms for typical, 
average or normal children. Since we do not now have 
fully satisfactory norms, one of the functions of the 
laboratory at the present time should be : 

2. The establishment of thoroughly reliable anthropo- 
metric norms for normal children. To be sure, we already 
have anthropometric norms for certain functions, e.g., 
those worked out by the Department of Child Study and 
Pedagogic Investigation of the Chicago schools. These 
norms are perhaps reliable so far as they go, and have 
sufficient validity to enable us to proceed at once, without 
awaiting confirmatory or more elaborate measurements, 
to measure and grade, with considerable confidence, any 
given cliild, whether subnormal, normal or supernormal. 
Yet the fact remains that it is still desirable to repeat 
Smedley's percentile measurements (or measurements 
designed to give anthropometric indices, Avhichever type 
of measurement ultimately will prove the more valuable) 
on height, weight, vital capacity, manuometry, endurance 
and other functions on a much larger scale and under more 
satisfactory conditions.^ For Smedley's norms are not 
entirely satisfactory in four respects : 

In the first place, they are based upon the examination 
of too few persons. To secure thoroughly reliable normal 
norms we should examine at least 1,000 persons of each 

8 The task involved in gathering reliable mental and physical norms, 
for both children and adults, is herculean, and would require the 
combined efforts of many workers. The work should be organized 



108 MENTAL HEALTH OF SCHOOL CHILD 

sex for each year, and each one-half year during early 
childhood. Smedley's numbers for given ages ranged from 
44 (ages nineteen and twenty, boys) to 448. I do not 
believe that in a country like the United States where so 
many nationalities commingle we can be satisfied with one 
hundred for each age. 

In the second place, we have no evidence that the norms 
are normal norms; i.e., that they are based upon the exami- 
nation of typical or normal children. In fact, the proba- 
bility almost amounts to a certainty that a considerable 
number of the pupils examined were more or less subnormal 
or abnormal. It is, therefore, possible that the percentile 
curves or indices for any case of retardation plotted on the 
basis of these results will misrepresent the development of 
the pupil in comparison with normal children. Measure- 
ments seem to show that anthropological indices are 
atj^pical for mentally abnormal persons. 

Of course, the concept of a normal norm — a typical, 
normal individual — is quite fluid or elastic. How shall we 
determine who is normal in advance of making the tests.'' 

by a public or endowed private bureau of research, so that it may 
be done with sufficient thoroughness, so that uniform or standardized 
methods may be used, and so that the results may be worked up in 
the most serviceable form. Properly to study any given individual — 
normal, criminal, insane, demented, amented — we must have individual 
and typical percentile curves or indices of physical development, and 
standards of mental attainment for various ages. 

I know of no form of public service which merits more fully the 
liberal support of philanthropic persons who have the interests of 
child reclamation or eugenics at heart. It is a work that should be 
munificently endowed. One of the essential functions of the Russell 
Sage Foundation, and the Government Bureau of Child Welfare, 
might well be the establishment of mental and physical norms of 
development. Meanwhile, our psycho-clinical school laboratories 
should contribute their mite toward obtaining these norms for 
persons of school age. 



NEW CLINICAL PSYCHOLOGY 109 

This is extremely difficult to say. Unless we are satisfied 
to use random, unselected groups and assume a symmetri- 
cal curve of distribution, we must adopt some criteria. 
So far as I know there are only two criteria which are at 
all available for selecting normal school children : namely, 
school grade (pedagogical status) and degree of physical 
defectiveness. 

On the basis of the first standard, the pupils of a given 
age who satisfactorily carry the work of the school grade 
to which they chronologically belong (or of an earlier 
grade in case of late entrance), may be considered mentally 
normal. 

The other method of selection is based upon the physical 
and medical examination of the child. That child may be 
regarded as physically normal who does not possess serious 
physical defects, or in whom the ravages of infant and 
childhood diseases have not resulted in pronounced physi- 
cal impairment. In other words, those children would be 
physically normal who suffer only from the ordinary 
amount of physical defectiveness. Even under the best 
conditions of modern life, the cliild with assumed 'normal' 
motor and sensory equipment will show some traces of 
physical defectiveness (21, 22). It is, therefore, chiefly 
important to exclude all the extreme departures from 
physical normality. 

Both of these methods of selection are practical, and 
the norms obtained by them ought more genuinely to 
represent normal norms than the norms obtained by testing 
unselected cases. The vahdity of the latter must always 
rest on the assumption that there are just as many super- 
normal or accelerated as subnormal or retarded indivi- 
duals. This I regard as improbable. Norms secured 
according to the above suggestions would not only give us 



110 MENTAL HEALTH OF SCHOOL CHILD 

valuable measures of the mental and physical powers and 
capacities of people of the present generation — racial and 
national indices — but indices by means of which to deter- 
mine the character and extent of the changes in human 
functions which are gradually taking place through hered- 
itary propulsion and environmental influences. 

In the third place, Smedley's range of ages, from four 
to twenty-one (or 'twenty-one years and over'), is too 
limited. It embraces merely the periods of childhood and 
adolescence. We need norms for infancy and the adult 
or the ebb period of life as far as the age of forty or fifty, 
at least. Such norms would perhaps have no immediate 
practical value for the public schools, juvenile courts or 
correctional and rescue homes for the young, but to the 
student interested in the scientific study of the problems 
of human evolution or in the study of the degenerative, 
involution, senescent changes peculiar to the process of 
aging, or in the study of the various physical and mental 
deviations peculiar to various classes of defectives (feeble- 
minded, epileptic, insane, criminal, paralytic, etc.), they 
would possess unusual value. At the present time we have 
little knowledge that is scientifically accurate regarding 
the growth (developmental or retrogressive) changes 
peculiar to middle and old age, because the norms are 
practically nonexistent. 

In the fourth place, Smedley's percentiles are given for 
whole ages only — 4, 5, 6, 7, 8, 9, etc. A child who is six 
years and one day old is grouped with one who is six years 
and 364 days old. Consequently, children who are prac- 
tically one year apart in age may be grouped together. 
This tends to introduce a considerable error, owing to the 
kaleidoscopic developmental changes which occur during 
the growth period. During this period the results which 



NEW CLINICAL PSYCHOLOGY 111 

are valid for the youngest child of a given age may grossly 
misrepresent the oldest child of that age. Accordingly, a 
better plan would be to group children by half -ages, thus : 
4, 41/^, 5, 5l^, etc. Thus, the six-year group would include 
children from five years ten months (beginning of tenth 
month) to six years three months (end of third month), 
while the six and one-half-year group would include cliil- 
dren from six years four months (beginning of fourth 
month) to six years nine months (end of ninth month). 
(I am now establishing certain norms according to this 
plan.) In other words, children are grouped under a given 
age-designation whose age is within three months in either 
direction of that designation. For the years following, 
the early growth period of the present grouping by whole 
ages is probably satisfactory. 

What has been said above applies to all kinds of norms : 
it must be emphasized that the norms required are not 
merely physical and anthropometric, but also psychical 
and pedagogical. 

3. The establishment of thoroughly reliable psycho- 
logical norms of development for normal children. Every- 
thing that has been urged in respect to the need of estab- 
lishing normal anthropometric norms and indices applies 
to the establishment of normal mental age norms of the 
important intellectual, motor and emotional functions. 
It will be impossible to make strictly reliable tests until 
these norms are available on a much larger scale than we 
now have them. It is also important to establish reliable 
objective pedagogical age-norms: but this work is large 
enough to demand the services of a special division of peda- 
gogic research. 

4. The psycho-clinical laboratory, in the fourth place, 
should serve as a clearing-house for all types of mentally 



112 MENTAL HEALTH OF SCHOOL CHILD 

and educationally unusual children — a function which it 
should discharge jointly with the special schools or special 
classes. At the present time the special schools serve this 
function very inadequately ; they have become rather a 
dumping ground for the ne'er-do-wells, the offscourings, 
of the schools — a place to which they may be relegated 
indiscriminately in order to relieve the regular rooms of 
an intolerable incubus. After the backward child has been 
examined in the laboratory, he should be sent to a special 
class (one in charge of a teacher specially trained for 
special- room work), with specific recommendations, for 
further careful pedagogical observation and psychological 
study. He should be given a well-planned try-out for a 
while, the results of which should be sent to the laboratory. 
On the basis of these results — the clinical examination and 
special-room observation and testing — the director should 
recommend the transfer to, or the placing of the child in, 
his proper place — the special class for the feeble-minded, 
the special class for the backward, the ungraded class for 
the retarded (those merely retarded in one or more of the 
academic branches), the classes for the blind, deaf, crip- 
pled, tuberculous, anemic or speech-defective, or the insti- 
tutions for the feeble-minded or epileptic. Most elementary 
pupils who are mentally retarded more than four years are 
suffering from very serious permanent arrest, and are 
institutional cases. They should be separated from the 
merely retarded and the backward. The recommendations 
of the director should not be subject to reversal, except 
through action by the board or the superintendent. As a 
clearing-house for mentally unusual pupils, the laboratory 
would render an important service to the schools not per- 
formed by any existing agency. It is evident that to 
perform this service in the best possible manner the 



NEW CLINICAL PSYCHOLOGY 113 

laboratory must be directed by an authoritative specialist 
and have available full data from the other sources which 
we have already discussed. Where there is no complete 
bureau of school research, the psycho-educational labora- 
tory would logically assume the functions of such a bureau. 

5. A fifth function of the laboratory is the psycho- 
logical examination and efficiency appraisal of some of the 
applicants for vocational guidance. As already stated, 
it is preposterous to assume that the mass of children can 
be scientifically guided into vocational pursuits without 
such an examination. The director of the vocational 
bureau should be a psycho-educational expert, or the 
services of such an expert should be available to the 
bureau for the examination of at least all the candidates 
whose educational record indicates that they are mentally 
exceptional. 

6. The laboratory may also undertake the training of 
special-class teachers in the psycho-clinical methods of 
testing pupils. If it were feasible, the teachers might 
assist in giving some of the tests in the special schools 
under the supervision of the laboratory director. The 
percentage of retarded children is so large that it would 
probably be beyond the means of the laboratory to examine 
all the pupils who should be examined in a large school 
system. To apply merely the Binet-Simon tests 
thoroughly requires from forty minutes to an hour. How- 
ever, a distinctly better plan is to specially train one or 
two adaptable teachers in the methods of psychological 
testing, and let them devote all their time to giving some 
of the simpler tests. The more difficult tests and the final 
review of the cases should invariably be made by the expert 
clinical psychologist. 



114 MENTAL HEALTH OF SCHOOL CHILD 

7, Finally, another function of the laboratory might 
be the supervision of the curricula of the special schools 
and the offering of courses in the training school on the 
psychology and pedagogy of the various types of mental 
deviation or deficiency. No teacher should ever be 
assigned to special class work who has not received special 
training. It is obvious that to perform all these functions 
the laboratory would have to be organized on a compre- 
hensive basis. 

The Qualifications of the Clinical Psychologist or 
Psycho-educational Examiner 

1. He must be temperamentally adapted for the work. 
I do not know that this is first in importance, but mere 
knowledge of the methodological technique peculiar to 
psycho-clinical work does not necessarily make a successful 
examiner. The examiner must have the ability or knack 
to draw out the best the child has to give ; if he is obliged 
to force it out he is lacking in the very essentials of the 
work. Psycho-cHnical examination is not a forcing-out 
process. The examiner should, through word, action, 
demeanor and bearing, be able to calm, pacify, set at ease 
the nervous, excitable child ; and to encourage, incite, stim- 
ulate the phlegmatic, timid, taciturn, obstructed child. 
He must be genial, friendly, sympathetic, quick to praise 
and slow to criticise, and must be able to win the confidence 
of all. He must possess an unlimited reserve of patience 
with the frivolous, the resistant and the snail-like plodders. 
He must be versatile and resourceful, so that he can change 
his attitude and method of attack to suit all types of 
persons. There are persons who will respond only to 



NEW CLINICAL PSYCHOLOGY 115 

pressure and with whom stem measures will produce the 
best results. But they are entirely exceptional, 

2. It is not enough that he has a thorough grounding 
in the methods and results of analytical, descriptive, 
experimental, child, social, physiological and educational 
psychology ; he should have a definite, technical prepara- 
tion in clinical psychology. He should be conversant with 
its methods, standpoints, aims and results. Knowledge of 
structural psychology is not sufficient ; the best structural 
and experimental psychologist may make the sorriest 
clinical psychologist. Often the paramount need is the 
ability to tear loose from the abstractions, schematizations 
and viewpoints of the structuralist. The clinical worker 
must use the 'case' method of procedure; he must be 
familiar with the clinical method ; he must be able to indi- 
vidualize each case (a capacity that is likewise needed by 
the special-class teacher), to study it in the concrete, to 
frame a clinical picture of it — in a word, to examine clini- 
cally. To do this requires more than a mastery of the 
framework of psychology or of the technique of laboratory 
experimentation ; it requires ready powers of observation, 
keenness of insight, power to interpret, ability to notice 
signs and symptoms, a knowledge of symptomatology and 
of the best available methods of psycho-clinical diagnosis, 
and an extensive first-hand acquaintance with education- 
ally abnormal children — three to four years of observation 
and testing in and out of institutions of a considerable 
variety of child deviates, such as the feeble-minded, back- 
ward, retarded, accelerated, epileptic, incipient and devel- 
oped neurotics and psychotics, speech defectives, moral 
imbeciles. Until recently it was impossible to obtain 
adequate training in clinical psychology except through 
an apprenticeship with one of the few experts in the field. 



116 MENTAL HEALTH OF SCHOOL CHILD 

Now a few universities — although very few — are able to 
oifer satisfactory didactic and clinical courses in the psy- 
chological and educational examination of children. 

3. A knowledge of anatomy and pathology, of public 
and personal hygiene, of the common physical defects, of 
nervous and mental diseases, of psychopathology and psy- 
chotherapy, of pediatrics and normal physical diagnosis, 
is essential for a clinical psychologist working on juvenile 
cases in the medical school; I incline strongly to the 
opinion that the psychological and educational examiner 
of mentally unusual children in the schools should also have 
a working knowledge of these specialties, 

4. The chnical psychologist should be thoroughly 
grounded in the science and art of normal pedagogy. He 
will certainly be able to render a higher type of service if 
he has had practical teaching experience in the elementary 
grades of the public schools, so that he has had the oppor- 
tunity to come directly in touch with the problems of the 
training, growth and development of the child mind, and 
so that he is thoroughly conversant with the normal peda- 
gogy of the elementary branches (particularly the 
methods of teaching handwork, reading, spelling, number 
and writing). He will likewise be better prepared for his 
work if he has taught educational psychology or the prin- 
ciples of teaching in training schools for teachers, so that 
he is alive to the vital educational problems concerning 
pedagogical methodology (questions regarding methods of 
studying, learning, instructing, drilling, memorizing, 
initiative, working efficiency, hours, rests, alternation 
of subjects, etc.) and so that he may thus turn his investi- 
gations to wider pedagogical use. 

5. He must have made a very exhaustive study of all 
phases of corrective pedagogics. He must be thoroughly 



NEW CLINICAL PSYCHOLOGY 117 

grounded in the differential pedagogy which applies to the 
types of cases he expects to handle. 

This may seem like an extremely exacting course of 
training but it is not more exacting than the training now 
demanded of the various medical specialists and it will 
certainly only make a reasonable demand on the time of 
the student who from the outset — at least from the bacca- 
laureate — shapes his work towards the career of a psycho- 
educational examiner. Certainly the work is so varied, 
complex and technical that complete mastery is out of 
the question without three or four years of preparation. 
Eventually the well-trained specialist in this field must 
command the respect and the emoluments accorded to the 
specialist in the allied medical fields. 



References 

1. BoBERTAG. Uber Intelligenzpriifungen (nach der 
Methode von Binet und Simon). Zeitschrift fiir ange- 
wandte Psychologie, 1911, 5: lOSfF. 

2. BoEHNE. Special Classes in the Rochester Schools. 
Journal of Psycho-Asthenics, 1909-10, 14:83. 

3. Cattell. a Further Statistical Study of American Men 
of Science. Science, 1910, N. S., 32: 672f. 

4. Dearborn. Medical Psychology. Medical Record, 
January 30, 1909. 

5. Dubois. The Psychic Treatment of Nervous Disorders. 
New York, 1906. 

6. Foster. Physiological Age as a Basis for the Classifi- 
cation of Pupils Entering High Schools — Relation of 
Pubescence to Height. The Psychological Clinic, 1909, 
3: 83f. 

7. Franz. On Psychology and Medical Education. Science, 



118 MENTAL HEALTH OF SCHOOL CHILD 

1913, 38: 555f. See also the statistical study of Abbot, 
Psychology and the Medical School. American Journal 
of Insanity, 1913, 70: 447f. 

8. Gayler. Retardation and Elimination in Graded and 
Ungraded Schools. The Psychological Clinic, 1910, 
4:40f. 

9. Gayler. A Further Study of Retardation in Illinois. 
The Psychological Clinic, 1910, 4: 79f. 

10. GoDDARD. The Grading of Backward Children. The 
De Sanctis Tests and the Binet and Simon Tests of 
Intellectual Capacity. The Training School, November- 
December, 1908. 

11. GoDDARD. Binet's Measuring Scale for Intelligence. The 
Training School, 1910, 6: No. 11. Revised edition, 
1911. 

12. GoDDARD. Two Thousand Normal Children Measured 
by the Binet Measuring Scale of Intelligence. Peda- 
gogical Seminary, 18:232f. 

13. GuLicK. Causes of Dropping Out of School. World's 
Work, August, 1910, 13285f. 

14. HuEY. Backward and Feeble-minded Children. Balti- 
more, 1912. 

15. HuEY. The Present Status of the Binet Scale of Tests 
for the Measurement of Intelligence. Psychological 
Bulletin, 1912, 9: 160f. 

16. J. Progress and Retardation of a Baltimore Class. 
The Psychological Clinic, 1909, 3: 136f. 

17. Jones. Psycho-analysis in Psychotherapy. Montreal 
Medical Journal, 1909, 38:495f. 

18. KuHLMANN. Binet and Simon's System for Measuring 
the Intelligence of Children. Journal of Psycho- 
Asthenics, 1911, 15: Nos. 3, 4. 

19. KuHLMANN. The Present Status of the Binet and Simon 
Tests of the Intelligence of Children. Journal of Psycho- 
Asthenics, 1912, 16: No. 3. 



NEW CLINICAL PSYCHOLOGY 119 

20. MacMillan. The Physical and Mental Examination of 
Public School Pupils in Chicago. Charities and Com- 
mons (now The Survey), December 22, 1906. 

21. Meumann. Sammelreferat iiber die Literatur der 
Jugendkunde. Archiv fiir Psychologic, 25: 85f. 

22. MuNRo. Psychotherapy in Relation to the General Prac- 
tice of Medicine and Surgery . The Medical Herald (St. 

Joseph), June, 1910. 

23. MuNSTERBERG. On the Witness Stand, Essays on Psy- 
chology and Crime. New York, 1908. 

24. MuNSTERBERG. Psychothcrapy. New York, 1909. 

25. MuNSTERBERG. Psychology and Industrial Efficiency. 
Boston, 1913. 

26. ScHMiTT. Retardation Statistics of Three Chicago 
Schools. The Elementary School Teacher, 1910, 478f. 

27. Taylor. The Widening Sphere of Medicine. The Har- 
vard Medical School, 4: (Quoted under 'The Doctor and 
the Public'), Science, 1910, N. S., 32: 664. 

28. Terman and Childs. A Tentative Revision and Exten- 
sion of the Binet-Simon Measuring Scale of Intelligence. 
Journal of Educational Psychology, 1912, 3: 61 f. 

29. Town. Translation of Binet and Simon's A Method of 
Measuring the Intelligence of Young Children.' Chicago, 
1913. 

30. Wagner. Retardation, Acceleration and Elimination in 
Mauch Chunk Township, Pennsylvania. The Psycho- 
logical Clinic, November, 1909, 3. 

31. Wallin. Experimental Studies of Mental Defectives. 
Baltimore, 1912. 

32. Wallin. The Rationale of Promotion and Elimination 
of Waste in the Elementary and Secondary Schools. The 
Journal of Educational Psychology, 1910, 1: 445f. 

33. Whipple. Manual of Mental and Physical Tests. Balti- 
more, 1910. Chapter 13. (Indispensable to examiners 
of children.) 



120 MENTAL HEALTH OF SCHOOL CHILD 

34. Wither. Clinical Psychology. The Psychological 
Clinic, 1907, 1: If. 

35. Wither. The Psychological Clinic. Old Penn, 1909, 
7:98f. 

36. WooLLEY. Charting Childhood in Cincinnati. The Sur- 
vey, 1913, 601 f. 

Additional references: 

Groszhann. The Study of Individual Children. Plainfield, 
1912. 

HoLHEs (Arthur). The Conservation of the Child. Phila- 
delphia, 1912. 

HoLHES (W. H.). School Organization and the Individual 
Child. Worcester, 1912. 

Wither (and others). The Special Class for Backward Chil- 
dren. Philadelphia, 1911. 



CHAPTER III 

CLINICAL PSYCHOLOGY: WHAT IT IS AND 
WHAT IT IS NOT^ 

On an occasion like this" it would seem proper, repre- 
senting as I do one of the newest of the sciences, that I 
address myself to some of the basic questions of this science. 
Perhaps the very first question with wliich one is con- 
fronted is simply this : 'In view of the rapid multiplication 
of the sciences, by what right does clinical psychology lay 
claim to an independent existence?' That is a question 
which may perturb some sensitive minds, but it does not 
disconcert the clinical psychologist, for he regards the 

1 Reprinted from Science, 1913, pp. 895-902. 

2 Substance of an address delivered before the Conference on the 
Exceptional Child, held under the auspices of the University of Pitts- 
burgh, April 16, 1913. Lest misapprehensions arise, it should be 
clearly understood that in this discussion I am concerned only with 
the relation of clinical psychology to mentally exceptional school chil- 
dren; and that I distinctly recognize a different type of exceptional 
children, namely, the physical defectives. The physical defectives 
should be examined by skilled pediatricians. The clinical psychologist 
is interested in physically exceptional children when they manifest 
mental deviations. Moreover, while I hold that the psycho-clinical 
laboratories must become the clearing houses for all types of 
mentally or educationally exceptional children in the schools, nearly 
all mentally exceptional children should be given a prior physical 
examination by consulting or associated medical experts. Physical 
abnormalities should, of course, be rectified, whether or not it can be 
shown that they sustain any causal relation to the mental deviations 
which may have been disclosed in the psycho-clinical examination. 
They should claim treatment in their own right. 



122 MENTAL HEALTH OF SCHOOL CHILD 

question as perfectly legitimate and capable of satis- 
factory answer. 

It is just and proper that a new claimant to membership 
in the family of sciences should be required to present her 
credentials. It is a natural human trait to challenge or 
contest the claims of a newcomer. It has ever been thus. 
Every branch of knowledge before winning recognition as 
an independent science has been forced to demonstrate that 
it possesses a distinct and unique hody of facts not ade- 
quately treated by any other existing science ; or that it 
approaches the study of a common hody of facts from a 
unique point of view, and with methods of its own. Psy- 
chology, bio-chemistry, dentistry, eugenics, historiometry 
and many other sciences have been thus obliged to fight 
their way inch by inch to recognition as independent 
sciences. It is not long since physiology claimed psy- 
chology as its own child and stoutly contested her rights to 
existence ; nor is it long since medicine denied any right to 
independent existence to dentistry. It is no surprise that 
a number of sciences now claim clinical psychology as part 
and parcel of their own flesh and blood, and that they 
deny her the right to 'split off from the parent cell' and 
establish an unnursed existence of her own. Just as nature 
abhors a vacuum, so science abhors the multiplication of 
sciences; just as the big corporation octopus in the indus- 
trial world tries to get monopolistic control of the sources 
of production and distribution, so the various sciences, 
naturally insatiable in their desire for conquest, attempt 
only too often to get monopolistic control of all those 
elements of knowledge wliich they may be able to use for 
their own aggrandizement, whether or not they have devel- 
oped adequate instruments for scientifically handling those 
elements. 



CLINICAL PSYCHOLOGY 123 

Clinical psychology, however, is quite ready to contest 
the attempts to deprive her of her inalienable rights to the 
'pursuit of life and happiness.' Fundamentally, she bases 
her claims to recognition as an independent science on the 
fact that she does possess a unique body of facts not ade- 
quately handled by any existing science, and that she 
investigates these facts by methods of her own. These 
facts consist of individual mental variations, or the phe- 
nomena of deviating or exceptional Tnentality. In other 
words, clinical psychology is concerned with the concrete 
study and examination of the behavior of the mentally 
exceptional individual (not groups), by its own methods of 
observation, testing and experiment. 

In the study or examination of individual cases, the 
clinical psychologist seeks to realize four fundamental 
aims : 

1. An adequate diagnosis or classification. He 
attempts to give a correct description of the nature of the 
mental deviations shown by his cases ; he tries to deter- 
mine whether they are specific or general, whether they 
affect native or acquired traits ; he attempts to measure 
by standard objective tests the degree of deviation of 
various mental traits or of the general level of functioning ; 
he seeks to arrive at a comprehensive clinical picture, to 
disentangle symptom-complexes and to reduce the disorders 
to various reaction types. 

2. An analysis of the etiological background. His 
examination is bent not only on determining the present 
mental status of the case, but on discovering the causative 
factors or agents which have produced the deviations — 
whether these factors are physical, mental, social, moral, 
educational, environmental or hereditary. In order to 
arrive at a correct etiology, the psycho-clinician makes not 



124 MENTAL HEALTH OF SCHOOL CHILD 

only a cross-section analysis of the case, but also a longi- 
tudinal study of the evolution of the deviation or symptom- 
complex. Therefore, he does not Kmit himself merely to a 
psychological examination, but requires a dento-medical 
examination and a pedagogical, sociological and heredi- 
tary examination. The physical examination should be 
made by experts in dentistry and in the various specialties 
in the field of medicine. The psycho-cHnicist, however, 
should be so trained in physical diagnosis that he can 
detect the chief physical disorders, so that he can properly 
refer his cases for expert physical examination. 

3. A determination of the modification which the dis- 
order has wrought in the behavior of the individual. He 
should determine what its consequences have been: what 
effects it has had upon his opinions, beliefs, thoughts, dis- 
position, attitudes, interests, habits, conduct, capacity for 
adaptation, learning ability, capacity to acquire certain 
kinds of knowledge or various accomplishments, or to do 
certain kinds of school work. He should seek to locate 
the conflicts between instincts and habits which may have 
been caused by the deviations. 

4. The determination of the degree of modifiahility 
of the variations discovered. Can the deviations be cor- 
rected or modified, and if so to what extent and by what 
kinds of orthogenic measures? A clinical psychologist is 
no less a scientific investigator than a consulting special- 
ist ; he diagnoses in order to prognose and prescribe. His 
aim, first and last, is eminently practical. 

Basis of Selection of Cases 

The clinical psychologist selects his cases not so much 
on the nature of the cause of the deviations (whether 
social, hereditary, physical, pedagogical or psychological) 



CLINICAL PSYCHOLOGY 125 

as on the nature of the deviations themselves, and the 
nature of the treatment. He is interested in cases wluch, 
first of all, depart from the limits of mental normahty. 
Exceptional mentality, or, if you please, mental exception- 
ality is his first criterion. In the second place, he is inter- 
ested in those cases in which the nature of the treatment — 
the process of righting the mental variations, of straight- 
ening out the deviations, the orthogenesis- — is wholly or 
chiefly or partly educational. In the term educational I 
include training of a hygienic, physiological (in Seguin's 
sense), pedagogical, psychological, sociological or moral 
character. 

Grouping of Cases 

It is thus evident that the clinical psychologist may 
group his cases into two main classes. 

A. Those in which the mental variations are funda- 
mental or primary, and the physical disabilities only acces- 
sory or sequential. With these cases the treatment must 
be primarily educational and only secondarily medical. 
What types of children are included in this group .'^ 

1. Feeble-minded children. Feeble-mindedness for- 
merly was regarded as an active disorder — a disease — and 
was accordingly treated exclusively medically. The theory 
of causation was wrong and so the results were unsatis- 
factory. Since the year 1800 (Itard, the apostle to the 
feeble-minded) and particularly since the year 1837 
(Seguin, the liberator of the feeble-minded), it has become 
increasingly apparent that feeble-mindedness is an arrest 
of development ; and accordingly since that time the condi- 
tion has primarily been treated educationally instead of 
medically. This change in point of view has revolutionized 



126 MENTAL HEALTH OF SCHOOL CHILD 

the treatment of the feeble-minded. The person who did 
most to amehorate their condition is Seguin, whose method, 
almost entirely educational, has served as the model for the 
effective institutional work for the feeble-minded done since 
his day, although we have outgrown various details of his 
system. Moreover, it served as the chief inspiring force 
for the constructive orthogenic work done for the feeble- 
minded within the last decade or so by Montessori. She, 
herself a physician, but with special training in psychology 
and pedagogy, tells us that in 1898, as a result of a careful 
study of the problem of feeble-mindedness she became per- 
suaded that the problem was primarily a pedagogical and 
not a medical one. It is granted without question, of course, 
that there is a medical side to the care of the feeble-minded 
just as there is a medical side to the care of the normal 
child. Nay, owing to the heightened degree of suscepti- 
bility to disease and accidents found among the feeble- 
minded, the medical side looms larger in the care of the 
feeble-minded than in the care of normals. Indeed, no 
institution for the feeble-minded can be properly organized 
without an adequate staff of medical experts ; but funda- 
mentally the problem of ameliorating the sad lot of 
feeble-minded children is an educational one — their 
hygienic, pedagogical and moral improvement, as well as 
their elimination by the method of colonization or sterili- 
zation. 

2. Retardates, technically so-called — of which there 
are probably on a conservative estimate 6,000,000 in the 
schools of the United States. Some of these are retarded 
(1) merely pedagogically in a relative sense — relative to 
an arbitrary curricular standard. Many children do not 
fit the standard, because the standard itself is off the 
norm. It is largely a case of a misfit curriculum instead 



CLINICAL PSYCHOLOGY 127 

of a misfit child. So far as this class of misfits is con- 
cerned, the problem is simply one of correct adjustment of 
the pedagogical demands of the curriculum. 

A considerable percentage of the retardates, however, 
are retarded because of (2) genuine mental arrest of 
development. They are as truly arrested or deficient as 
the feeble-minded, but to a lesser extent. The difference 
is a quantitative and not a qualitative one, and the prob- 
lem of correction consists fundamentally in providing a 
right educational regimen. 

Then there is (3) a smaller proportion of retardates 
who are mentally retarded because of environmental handi- 
caps, such as bad housing, home and neighborhood condi- 
tions, bad sanitation, lack of humidity, lack of pure air 
or excessive temperature in the schoolroom, vicious or 
illiterate surroundings, frequent moving or transfer, emi- 
gration which may cause linguistic maladaptation, etc. 
With such retardates the problem is partly sociological, 
partly hygienic and partly pedagogical. 

We have a final group of children (4) who are mentally 
retarded because of some physical defect. With children 
of this type the problem is partly medical and partly 
educational. The first eff^orts made in behalf of such 
children should be medical and hygienic. Undoubtedly the 
removal of physical handicaps will restore some pupils to 
normal mentality, while in the case of other pupils the 
results will be negative. Unfortunately many of the 
studies in this field (see Chapter XV) have a questionable 
value because of the obvious, but evidently unconscious 
bias of the investigators. Some desire to show favorable 
results and, therefore, unconsciously select only the favor- 
able cases ; others are swayed by the opposite motive and 



128 MENTAL HEALTH OF SCHOOL CHILD 

accordingly tend to select the negative cases. Hence, at 
the present time we find considerable diversity of opinion 
as to the orthogenic influences of the correction of physical 
disorders. The opinion of John J. Cronin, M.D., probably 
approximates the truth : 

The successes simply mean that a large number of children 

were perfect except for some one abnormality The 

alleviation of any single kind of physical handicap is merely 
one step towards the successful result sought, and many other 
factors must obtain before some measure of success is assured. 

Likewise A. Emil Schmitt, M.D. : 

It should constantly be borne in mind that if every physical 
defect has been successfully removed the mental unbalance or 
deficiency can remain unaltered, inasmuch as it was primarily a 
mental defect and can be reached only by methods of educa- 
tion or psychological treatment. 

While I am quite convinced that all mentally retarded 
children should undergo a careful physical examination, 
and that such physical corrective measures should be 
applied as are indicated by expert medical opinion, yet it 
needs to be reemphasized that the removal of a physical 
disability is frequently only the first step toward restora- 
tion. If the child has fallen behind pedagogically or 
mentally, he will in many cases need special pedagogical 
attention if he is to catch step with the class procession; 
moreover, after a certain critical age has been passed, the 
removal of physical obstructions exercises only a slight 
orthophrenic influence, and the reestablishment of effective 
mental functioning, if it can be done at all, will require the 
prolonged application of a special corrective pedagogy. 

3. The supernormals. Both of the above types of 
children come on the minus side of the curve of efficiency. 



CLINICAL PSYCHOLOGY 129 

On the other side we find the plus deviates — the bright, 
brilHant, quick, gifted, talented, precocious children. 
These children may present no peculiarities on the physi- 
cal side, if we except the type of nervously unstable, pre- 
cocious children. With the healthy supernormal child the 
problem is almost entirely an educational one: the intro- 
duction of schemes of flexible grading; of fast, slow and 
normal sections, and of supernormal classes ; providing 
special opportunities for doing specialized work, and a 
special pedagogy, which should probably be as largely 
negative as positive. If there is any one child in our 
scheme of public education which has been neglected more 
than any other, it is the child of unusual talents. A nation 
can do no higher duty by its subjects than to provide those 
conditions wliich will rescue its incipient geniuses from the 
dead-level of enforced mediocrity. 

4. Speech defectives, particularly the 2 per cent 
(approximately) of stutterers and hspers who encumber 
our classes. In few fields of scientific research is it possible 
to find such astonishing diversity of so-called expert 
opinion as on the question of the causation of stuttering 
(or stammering). It is claimed to be a gastric, pneumo- 
gastric, lung, throat, lip, brain, hypoplastic, nervous and 
mental disorder. It is said to be a form of epilepsy, a 
form of hysteria and a form of mental strife, or repression, 
between latent and manifest mental contents. Moreover, 
few writers show such a consummate genius for self-con- 
tradiction as writers on stuttering. Before me lies a 
reprint of a recent dissertation on the 'Educational Treat- 
ment of Stuttering Children.' The writer begins by saying 
that stuttering is a 'pathological condition,' a disease, and 
that, therefore, its treatment belongs to a specialist on dis- 
eases. The disease appears, however, on the second page 



130 MENTAL HEALTH OF SCHOOL CHILD 

to be merely 'a purely functional neurosis,' while on the 
last page the trouble is nothing more than a 'mental one,' 
caused by influences acting on the mind. As a matter of 
fact, the treatment which the writer recommends is, 
through and through, educational and largely psychologi- 
cal. It consists of certain physical exercises, designed not 
so much to strengthen certain organs as to win the 
patient's interest and restore his self-confidence ; and 
certain psycho-therapeutic and hypnotic exercises. 

Waiving for the time being the nature of the cause, we 
can agree on one thing; namely, that the methods of 
treating stuttering (and lisping) which have been proved 
effective are almost exclusively educational. Many of the 
neurotic symptoms ('functional neuroses') found in the 
stutterer are the results of mental tension and will dis- 
appear with the correction of the stuttering. 

5. Incipient psycJiotics, or children who show develop- 
mental symptoms of mental disorders or mental alienation. 
Here we meet with the same controversy between the advo- 
cates, on the one hand, of a somatogenic theory, and, on 
the other hand, of a psychogenic theory of causation. 
While it must be admitted that many of the psychoses are 
certainly organic, others almost as certainly are functional 
and are produced by idiogenic factors (a view entertained 
by such well-known psychiatrists as Meyer, Freud, Janet, 
Dubois, Jones, Prince). Now, irrespective of whether the 
cause is chiefly physical or mental, it is being recognized 
by a number of the leading present-day psychiatrists that 
drug treatment for the majority of the insane, whether 
juvenile or adult, is secondary to the educational treat- 
ment. Instead of merely prescribing physical hygiene for 
the insane, leading alienists are now prescribing mental 
hygiene. The cure is being conceived in terms of a 



CLINICAL PSYCHOLOGY 131 

process of reeducation. Moreover, so far as concerns the 
mentally unstable child in the schools, the chief reliance is 
obviously on hygienic and educational guidance. 

B. Cases in which the physical deviations are funda- 
mental or primary, and the mental variations sequential, 
but the remedy partly or chiefly educational. Here we 
include malnutrition, rickets, marasmus, hypothyroidism, 
tuberculosis, heart trouble, chorea and similar diseases. 
In all of these the treatment must be primarily medical, 
although there should be a special temporary educational 
regimen for these children. This group also includes the 
blind and the deaf. But here the treatment is almost 
wholly educational. The physical defects are incurable, 
but the mental defects can be partly overcome by proper 
compensatory educational treatment. The epileptic also 
must be added to this group. Epilepsy is evidently an 
active disorder or disease process, although the pathology 
is wrapped in the deepest obscurity. The epileptics appear 
like purely medical cases. The medical aspect certainly is 
important, but the records show that only from 5 to 10 
per cent are curable, and that the attacks can be as 
readily modified or regulated in most cases by proper 
hygienic treatment as by drug medication or surgical 
interference. To quote Montessori: 

Benedickt, and following him, the principal authorities 
among medical specialists, are at present condemning the use 
of depressing bromides, which hide the attacks as an anes- 
thetic hides pain, but do not cure them. The cure, says Bene- 
dickt, depends upon hygienic life in the open in order to 
absorb the poisons, and upon work, rationally measured and 
graded, provided, however, that the malady is still recent and 
has not assumed a chronic form. The treatment consists in 
educating them. 



132 MENTAL HEALTH OF SCHOOL CHILD 

Even with these unfortunates, it can be said that the best 
results come from a proper medico-educational regime — 
colonization, outdoor employment, industrial schooling, 
bathing, etc. 

Summary of Important Conclusions 

We are thus brought to the two following conclusions : 

1. There is a set of unique facts — facts of individual 
mental variation — which no existing science has adequately 
treated. It is with these facts that the work of the clinical 
psychologist is concerned. Just as psychology became an 
independent science by demonstrating that it possessed a 
legitimate claim to a unique world of facts, so clinical psy- 
chology is ready to make her declaration of independence 
and dedicate herself to the investigation of a body of 
facts — facts of individual mental variation — not hitherto 
adequately handled by any existing science. It is con- 
cerned with the study of individual cases of deviate men- 
tahty, particularly with those types which are amenable to 
improvement or correction by psycho-educational pro- 
cesses. 

2. The proper handling of these cases, whether for 
purposes of examination, recommendation or prescription, 
can only be done by a psycho-educational specialist who 
possesses the training indicated in Chapter II. 

The Relations of Clinical Psychology — Some 
Affirmations and Denials 

There are a number of sciences with which cHnical psy- 
chology is, will be or should be closely related, but which 
are not synonymous with clinical psychology. 

1. Clinical psychology is not the same as psychiatry 



CLINICAL PSYCHOLOGY 133 

(and psychopathology) . The typical alienist is concerned 
with the study and treatment of mental disorders (tech- 
nically called psychoses) ; the clinical psychologist, on the 
other hand, is concerned particularly (though not solely) 
with the study of plus and minus deviations from normal 
mentality. The aUenist works cliiefly with adults, the 
clinical psychologist with children. Few alienists possess 
any expert knowledge of the literature bearing on child or 
educational psychology, mental deficiency, retardation or 
acceleration, stuttering or lisping, special pedagogy or 
psycho-clinical methods of testing. An alienist accord- 
ingly is not to be considered a specialist on the mentally 
exceptional child in the schools unless, indeed, he has sup- 
plemented his general medical and psychiatric education 
with a technical study of the psychological and educational 
aspects of the problem. The alienist of the future will 
certainly have to secure a different preparation from that 
now furnished in the medical schools, if he is to enter the 
field of pedagogic child study. 

Before me lies the report of the department of medical 
inspection of a large school system. Six hundred retarded 
children were examined in this department, which is in 
charge of an alienist, who, as I am told, is an expert on 
the questions of adult insanity, but who has no specialized 
preparation in the psychology and pedagogy of the men- 
tally defective cliild. Of these cliildren 49.7 per cent are 
recorded as feeble-minded. Applying this figure to the 
6,000,000 retardates of the public schools of the country, 
we get a total feeble-minded school population of 8,000,- 
000. This figure, it need scarcely be said, is monstrously 
absurd. It is fully ten times too large. Feeble-mindedness 
and backwardness in children, it must be said, are distinct 
problems from mental alienation, and require for their 



134 MENTAL HEALTH OF SCHOOL CHILD 

satisfactory handling a specialist on mentally deviating 
children. A high-grade feeble-minded child can not be 
identified merely by some rule-of-thumb system of intelli- 
gence tests. Feeble-mindedness involves more than a given 
degree of intelligence retardation. At the same time, lest 
I be misunderstood, it should be specially stated that psy- 
chiatry and clinical psychology will be mutually helped by 
a closer union. Clinical psychology has many important 
facts and a valuable experimental technique to offer to 
psychopathology, and psychopathology in turn is able 
to contribute facts of great value, and more particularly 
an effective clinical method of examination, to clinical psy- 
chology. As the idiogenic conception of the causation of 
various psychoses wins greater recognition, clinical psy- 
chology will become more and more indispensable to the 
psychiatrist and psychopathologist. It is also certain 
that the efficiency of the clinical psychologist will be 
greatly increased by a study of mental alienation — not a 
study of texts on psychiatry, but a first-hand study in in- 
stitutional residence of individual cases. Any one intend- 
ing to do psycho-clinical work with mentally deficient 
children certainly should spend at least a year or two in 
residence at institutions for feeble-minded, epileptic and 
alienated children. The clinical psychologist should be 
prepared to recognize cases of incipient mental disorder, 
so that he will be enabled to select these cases and 
refer them to a psychiatric or psychopathic specialist for 
further examination. 

2. Clinical psychology is not neurology. There are 
important neurological aspects involved in the study of 
mentally exceptional children. Mental arrest can be 
largely expressed in terms of neurological arrest, and a 
clinical psychologist should have a first-hand knowledge of 



CLINICAL PSYCHOLOGY 135 

nerve signs and a practical acquaintance with the methods 
of neurological diagnosis. His knowledge of neurology 
should be sufficient to enable him to pick out suspected 
nervous cases and refer them for expert examination by a 
neurologist. However, it must be emphasized that neurol- 
ogy touches only one side — though an extremely important 
side — of the problem of exceptional mentality. 

3. Clinical psychology is not synonymous with general 
medicine. The average medical practitioner certainly 
knows far less about the facts of mental variation in chil- 
dren than either the psychiatrist or neurologist or even 
the classroom teacher. This fact should occasion no sur- 
prise when it is stated that the study of psychology as a 
science has been practically ignored in medical curri- 
cula throughout the country. The clinical psychologist, 
however, as I have already said, should be able to detect 
the chief physical defects found in school children, so that 
if the laboratory of the clinical psychologist assumes the 
function of a clearing house for the exceptional child he 
may be able to refer all suspected medical cases to proper 
medical clinics for expert examination and treatment. 

4. Chnical psychology is not pediatrics. To be sure, 
the pediatrician deals with children. But his attention is 
focused on the physical abnormalities of infants ; his inter- 
est in the phenomena of mental exceptionaHty is liable to 
be incidental or perfunctory. In fact, one may read some 
texts on pediatrics from cover to cover without so much 
as arriving at a suspicion that there is a body of unique 
facts converging on the phenomena of departure from the 
limits of mental normality which require intensive, special- 
ized, expert study and diagnosis. So far as the physical 
ailments or disabilities of young children are concerned the 
pediatrician is in a position to render valuable service to 



136 MENTAL HEALTH OF SCHOOL CHILD 

the psycho-clinicist ; likewise so far as concerns the mental 
deviations of children the psycho-cHnicist is able to render 
valuable aid to the pediatrician. But one must not confuse 
pediatrics with clinical psychology. 

5. CHnical psychology is not the same as introspective, 
educational or experimental psychology. It differs from 
these in its method, standpoint and conceptions. While 
the clinical psychologist should be grounded in introspec- 
tive and, especially, experimental, educational and child 
psychology, expertness in these branches of psychology 
does not in itself confer expertness in practical psycho- 
clinical work. Such expertness comes only from a technical 
training in clinical psychology and from a first-hand pro- 
longed study by observation, or experiment, or test of 
various kinds of mentally exceptional children, particu- 
larly the feeble-minded, the psychopathic, the epileptic 
and the retarded. The skilled specialist in experimental 
or educational psychology or experimental pedagogy is 
no more qualified to clinically examine mental cases, than 
is the skilled zoologist, physiologist or anatomist able to 
clinically examine physical cases. Clinical work, both in 
psychology and medicine, requires clinical training. The 
assumption that any psychologist or educationist (and, 
forsooth, any physician or medical inspector) is qualified 
to do successful psycho-cKnical work, after learning how 
to administer a few mental tests, is preposterous and 
fraught with the gravest consequences. CHnical psychol- 
ogy can have no standing in the professions as long as we 
permit this absurd notion to prevail. 



CHAPTER IV 

THE FUNCTIONS OF THE PSYCHOLOGICAL 
CLINIC 

The psychological clinic is a very modern American 
creation. The first clinic was started in a small way only 
eighteen years ago in the University of Pennsylvania. 
The growth of these clinics was at first very slow, but 
during the last three or four years they have rapidly mul- 
tiplied (see statistics in Chapters II and XVIII). Besides 
the clinical psychologists there are a considerable number 
of teachers, nurses, physicians and others who are tyros or 
amateurs in psychology and psycho-educational thera- 
peutics, who are testing cliildren in schools, juvenile courts 
and institutions, but the work of most of these amateurs 
can scarcely be considered in speaking of clinical psychol- 
ogy or of psycho-clinical technicians. Professor O'Shea 
has recently predicted (School Review, April, 1913, p. 
285) that within a decade there will be a psychological 
clinic in every community with 2,500 or more school chil- 
dren. That may be so if we agree to call any place in 
wliich mental tests may be given a 'psychological clinic' 
The psychologist, however, would probably just as strenu- 
ously object to having these testing stations called 'psy- 
chological clinics' as the psychiatrists would object to 
having them called 'psychiatric chnics.' 

1 Reprinted, with alterations and additions, from The Medical 
Record, September 30, 1913. 



138 MENTAL HEALTH OF SCHOOL CHILD 

The development of the psychological clinic has come 
in response to a demand for more accurate psychological 
diagnosis — and this is the first function of the psycholo- 
gical clinic which I wish to discuss. 

1. Expert diagnosis of mentally deviating cases and 
expert prescription and consultation. The central aim of 
the psychological clinic is psychological diagnosis and con- 
sultation and advice in regard to mental cases, particularly 
children. In other words, the aim of the clinic is essen- 
tially practical. The clinical psychologist is engaged in 
serious work and not mere play. His interests are not 
confined to the theoretical or academic. His efforts are in 
the field of human conservation, individual orthogenesis 
and remedial philanthropy. All the psychological clinics, 
so far as I know, are doing philanthropic work. The 
psycho-clinicist is concerned with the proper mental 
hygiene, the correct educational classification and the 
skilled pedagogical training of the mentally exceptional 
child." The aim, in one word, of his basic effort is ortho- 
genesis (particularly that phase of orthogenesis to which 
I have applied the term 'orthophrenics'). 

It is rapidly becoming generally recognized that the 
nature and extent of mental variations or abnormalities 
cannot be adequately ascertained by the method of mere 
observation or inspection, or by the ill-adapted methods of 
specialists in the fields of medicine. Many mental devia- 
tions are so subtle that they entirely escape common obser- 

2 It would seem better to call the psychological clinics in the 
schools psycho-educational clinics, just because of the fact that the 
character of the diagnosis attempted is distinctly both psychological 
and educational, and because the aims of the diagnosis are dis- 
tinctly the scientific pedagogical training, correct educational classi- 
fication and mental hygiene of the educationally exceptional child. 



THE PSYCHOLOGICAL CLINIC 139 

vation. Common observation, moreover, rarely penetrates 
so far as to reveal the cause of the defect. Before the 
advent of experimental and clinical psychology, mental 
diagnosis was based almost wholly upon common observa- 
tion, if we except the pedagogical tests of the schools and 
a few tests of the trained psychopathologists. Many 
mental variations or abnormalities, however, are harder to 
get at by mere observation than many physical disorders. 
Many of the latter can be detected by the methods of so- 
called inspection, auscultation, palpation, percussion or 
mensuration. Nevertheless, the skilled physician does not 
depend solely upon these methods of diagnosis, but has 
developed a more refined laboratory technique, consisting 
of radiographic and microscopic inspection, serum reac- 
tion tests, mechanical and electrical tests of nervous 
sensitivity and response, etc. Likewise the psychologist 
within the last decade or two has developed a new science, 
which is now usually called 'clinical psychology,' and a 
delicate, controlled laboratory technique. This technique 
sometimes involves the use of the most delicate apparatus 
for precisely measuring the functional capacity of the 
various sensory, motor and intellectual processes. At other 
times it involves the use of less elaborate testing appliances. 
For purposes of practical mental diagnosis the tendency 
at the present time is to make a more extensive use of the 
simpler forms of testing devices, such as test blanks, form 
and construction boards, set questions and graded scales 
of intellectual, motor and socio-industrial capacity. The 
most popular of the developmental scales is the Binet- 
Simon scale of intelligence, which consists of a series of 
tests (sixty-two in the 1908 series if ages one and two are 
included) gradually increasing in difficulty and arranged 
in age-steps. There are from three to eight tests in each 



140 MENTAL HEALTH OF SCHOOL CHILD 

of the first thirteen years of Kfe in the 1908 series. Many 
of these tests are extremely simple. To illustrate : a child 
who can follow visually a lighted match moved in front of 
his face, who can grasp and handle a block placed in his 
hand and who can grasp a suspended cylinder is credited 
with a mentality of one year. A child who can state his 
sex, who can recognize and name common objects, such as 
a knife, penny and key, who can repeat three numerals 
heard once, and who can designate the longer or shorter 
of two lines differing by one centimeter, is rated as four 
years' old mentally. The scale is constructed merely to 
test the stage of the intelligence, and not emotional or 
motor development. The stimulus to the development of 
this scale was the enactment in Paris in 1904 of an edu- 
cational measure which required the individual examination 
of all mentally defective children. At first this work was 
left to the medical inspectors, but it soon became evident 
that they could do no more than they already had done in 
the way of medical inspection — namely, detect physical 
defects and diseases. It became evident that there was no 
scientific method of examining mentally exceptional chil- 
dren in existence, and hence Binet and his assistant, Simon, 
set about to establish normal mental age-norms by examin- 
ing certain pedagogically average children in the elemen- 
tary schools of Paris (children of the working classes from 
the poorer sections). They arranged certain tests in 
age-steps, and it is tliis arrangement of the tests into age- 
norms that has made the tests so popular. This scale is 
of considerable value for grading intelligence, but it has 
recently been subjected, particularly in this country, to 
indiscriminate exploitation and popularization, so that 
many erroneous ideas have arisen in respect to its real 
function or the real function of psychological examinations 



THE PSYCHOLOGICAL CLINIC 141 

in general. Almost everything that has been written about 
the Binet scale (until very recently) has been in the nature 
of praise— both judicious and extravagant, rather more 
of the latter. I think it is worth while, therefore, to call 
attention to some of the current misconceptions and to 
sound a few warning notes, regarding psychological 
examinations. 

1. Very many persons who are not trained mental 
examiners seem to think that the Binet testing is all there 
is to a mental examination ; that it is the only serviceable 
method we have ; that it is the Alpha and Omega of psy- 
cho-clinical work. Indeed, that is about all there is to the 
mental examinations conducted by amateurs. This is a 
preposterous notion. It is quite possible to give from one 
hundred to five hundred other valuable psychological tests 
in the examination of a case. Of any one single scheme of 
testing, the Binet scale is probably at present our most 
valuable instrument, but it is only one among many diag- 
nostic devices at the command of the trained psychological 
examiner. 

2. Another fact that needs to be emphasized again and 
again is that simply putting a child through the Binet 
scale does not tell one very much about his real mental idio- 
syncrasies, the peculiarities of his mental constellations, 
his particular shorts or longs. It does not give us a differ- 
ential diagnosis of type or of cause or a prognosis of 
outcome, except in certain very obvious cases. What the 
Binet scale does is to give one a preliminary, rough or 
approximate rating of the child's mental level. If the 
child is in the schools and has been carefully classified, we 
already have, through the pedagogical tests and grading, 
an approximation of his mental standing — often inaccu- 
rate, to be sure, just as the Binet rating sometimes is. 



142 MENTAL HEALTH OF SCHOOL CHILD 

All that can be expected from the Binet testing by persons 
who are not expert psychological examiners is usually 
merely an independent confirmation of the pedagogical 
rating already assigned the child in the schools. This may 
be of value. Sometimes, however, the Binet rating will be 
at variance with the teacher's rating, and I have known of 
cases in wliich teachers maintain that, because they have 
been coming into contact with the child and have been 
studying its mentality, day by day for months or years, 
their judgment in regard to the cliild's mental standing is 
more rehable than the judgment of a teacher, nurse or 
physician who has spent only a few minutes with the child 
in putting him through the Binet tests. 

It is doubtful whether the Binet tests will afford to an 
amateur in clinical psychology deeper insight into the 
operation of the child's mind than the pedagogical tests 
afford to the observant teacher. Certainly the Binet 
testing of itself will not confer any remarkable insight or 
comprehension upon any person using the scale. If he 
I already has accurate knowledge and deep insight into 
mental mechanisms, the Binet testing will better enable liim 
to use his skill, but without prior erudition or technical 
skill, the Binet testing is not a magical something that wiU 
transform a person into a mental wizard and give him 
occult powers to penetrate into a child's mental peculiari- 
ties and reveal the treatment he requires. The Binet 
testing is not a device for supplying brains or a substitute 
for a technical university course. It is just as preposter- 
ous to think that one can become a skilled mental examiner 
merely by reading books on mental tests, as to think that 
one can become a skilled surgeon by simply reading books 
on surgery. A clinical psychologist uses certain formal 
tests merely as the physician feels the pulse or takes the 



THE PSYCHOLOGICAL CLINIC 143 

temperature. A physician must know a good deal more 
than how to take the pulse or temperature in order to 
physically diagnose his cases. Because of the large num- 
ber of mental defectives in the schools, we shall always 
need a number of assistants to give certain psychological 
tests, but their function is that of the nurse in relation to 
the physician (see Chapters IX and X). 

3. In the third place, the notion has gotten abroad 
that the Binet scale is 'infallible' or 'amazingly accurate.' 
I have attempted to show that both of these statements are 
false, by minutely analyzing the results of the daily appli- 
cation of the scale for eight months to epileptics. Since 
these results have either been ignored^ or criticised because 
they have been based upon the testing of epileptics, I have 
used precisely the same method in giving the tests to public 
school clinic cases. Here there is space to give in briefest 
form the results merely of a threefold method of testing 
the scale with the public school cases which have been 
examined in the psycho-educational chnic of the School 
of Education, University of Pittsburgh. (For criticisms 
of the tests growing out of their use with epileptics, see 
Chapters VI, VII and VIII.) 

First, I have compared the Binet rating or classification 
with the pedagogical classification of the consecutive cases 
which were thoroughly examined. Age six to seven was 
considered as the normal age for Grade I. Briefly, the 
Binet rating gave 80.5 per cent as retarded, 2.7 per cent 
as exactly at age and 15.7 per cent as accelerated (based 
on 184 cases), while the pedagogical rating gave 89.4 

3 One of my recent critics ascribes the inaccuracy of the Binet 
work to the testers and not to the scale. My investigations, which 
have revealed the inaccuracy of the scale, have not yet been experi- 
mentally refuted; they cannot be refuted by bare denial. 



144 MENTAL HEALTH OF SCHOOL CHILD 

per cent as retarded, 8.5 per cent as on time, and only 2 
per cent as accelerated. 

Second, I have determined in units of years the gross 
amoimt of mental and pedagogical retardation and accel- 
eration of all those children tested whose school records 
were such as to make it possible to determine the degree of 
pedagogical deviation (134 cases). The mental variations 
were recorded in years and fractional parts of years by 
the point system used in the Binet scale; and the peda- 
gogical deviations were determined more or less according 
to the age-grade method. The difference between the 
point in the course where the child was at the time of the 
examination and where he should have been according to 
his age was determined in years and fractions of years. 
Graph I shows that the gross amount of Binet retardation 
amounted to 343.3 years as against 359.3 years of peda- 
gogical retardation; and the corresponding figures for 
acceleration were 24.4 years as against 6 years. By 
both of the above methods the retardation is seen to be less 
by the Binet than the pedagogical rating, while the amount 
of acceleration is decidedly more by the Binet than by the 
pedagogical rating. 

These methods of comparison, however, are subject to 
criticism, and I shall, therefore, pass on to the third and 
more important method. According to this, all the con- 
secutive cases which had been thoroughly examined (184 
cases) were first classified strictly according to the Binet 
system, with the exception that only those who were 
retarded more than three years were classified as feeble- 
minded, while children less than nine years chronologically, 
who were retarded two years or over or less than three 
years were not so classified. It is thus apparent that I 
have classified less cases by the Binet tests as feeble-minded 



TOT/JL /JMOUriT or BINET- 

siMon mo PED/JGOG/c/JL vmi/i- 

TION SHOWN BY 154 PITTSBURGH 
SCHOOL C/iSES. 



Retardation. 



545.3 



Ljrs. 



559.5 i/rs» 



B-S. 



Peda-^ 
^o^icaf. 



/Acceleration. 



GRAPH I. 



24.4 yrs. 

I 

B-5. 



6.yrs» 

Peda- 
gogical, 



CL/JSSIFIC/ITION or 
COnSECUTIVE CLimC CASES. 

Psychol, Clinic , Univ. of Pitt. 
Based on the Binef Testing (1908 scale). 



/9.5SS 



GRAPH II. 



/6,3% 



H.4% 



7.0% 



4.8% 



f.0% 
I 

N 



3.2% 






(N 



CM 

id 



Feeble -Minded^ 
27.7% 



17.3% 



&2%? 



2.7%i 



3M 



2.7% 



t 




t 


t 


r 




S, 


s 


^ 




:5^ 
CO 


CM 


O 




o 

9,' 


CM 




CM 




CM 


CM 


^ 


•K. 

o 

1 


CM 


tM 

c\i 



/Jccelerafed 
-^ /5,7X 



Normal 
2%2'A 



Retarded 60.5Z 



CL/Jss/F/c/fT/on or 

COtiSECUT/VE CLIhlC C/15ES. 
PsLjchol. Clinic, Univ. of Pitt. 

Based on all the pivailable Facts. 



39.2% 



GRAPH III. 



tt.6% 



8.855: 



6.6?'o 



.5% 



o 






V) 

o 



/./% 



o 



Feeble -Minded I7.0Z 



10 

I. 
o 



b 



Subnormal 77. 3 y. 



If. OX ".0% 



9.9% 









I 

b 



148 MENTAL HEALTH OF SCHOOL CHILD 

than the Binet system permits. In the second place, I have 
gathered all available data on the cases by other psycho- 
logical tests and by other inquiries, and have based my own 
diagnoses on a careful study of all the facts thus 
secured. A comparison of graphs II and III shows that 
there is a certain degree of correspondence between the 
two classifications. The Binet rating gives 4.7 per cent 
more supernormals and 2.6 per cent more subnormals. 
The most important difference, however, is in the number 
of feeble-minded and backward cases. The Binet rating 
gives 10 per cent more feeble-minded and from 15 to 20 
per cent less backward cases than the final estimate. 
If we also consider the pupils who were retarded three 
years (or two years if under nine years of age) as feeble- 
minded, the discrepancy would be perceptibly increased. 
It is entirely clear to my mind that 27 per cent of these 
I children (as shown by the Binet tests on the above basis) 
were not feeble-minded. I am entirely clear on the propo- 
I sition that the Binet rating in the hands of mere Binet 
\ testers will give us entirely too many feeble-minded cases. 
This conclusion seems to be abundantly confirmed by recent 
reports from Binet testers in the public schools. To cite 
only two instances : In one city 49.7 per cent of 600 re- 
tarded children (unselected retardates so far as I can 
gather) and in another 80 per cent of about 300 admis- 
sions to special classes, were classified as feeble-minded. 
In the latter city, the astonishing statement is made that 
this number includes only 15 per cent of the subnormals 
in the school system who should be in special classes. What 
a terrible focus of feeble-minded degeneracy this city must 
be ! Apply this same ratio of feeble-mindedness to the 
6,000,000 retarded children in the schools of the country, 
and we get a feeble-minded school population of from 



THE PSYCHOLOGICAL CLINIC 149 

3,000,000 to 4,800,000. Of course, this is ludicrously 
absurd. Even if the cases examined were rather extreme, 
the figures are still entirely extravagant. Very probably 
not more than from one-fourth to one-half of these retard- 
ates were feeble-minded. I will venture the assertion after 
years of teaching in the public schools and clinically exam- 
ining public school cases, that the oft-repeated statement, 
that '2 per cent of the general school population is defect- 
ive' (if by this is meant feeble-minded), exaggerates the 
real situation. The actual number is probably about 1 per 
cent. Incidentally I may say that the percentage of 
feeble-minded found among prostitutes by Binet testers 
is also too large. 

It is important to emphasize that so far as concerns the 
diagnosis of individual cases (rather than the statistical 
classification of homogeneous groups of cases), no system 
of formal intelligence tests yet devised can be used as an 
infallible measuring rod of intelligence. It is quite certain 
that if the psychological diagnosis of school children is to 
be intrusted to laymen, whether teachers, nurses or special- 
ists other than psychological experts, some very inaccurate 
and pernicious diagnoses will be made of individual cases. 
In my own laboratory my diagnoses of individual cases are 
often quite at variance with the Binet findings. I have 
sometimes diagnosed cases with only a slight degree of 
intellectual arrest as 'feeble-minded' because that is the 
prognosis (one two-year old who will probably remain at 
two, tested normal), while I have sometimes diagnosed 
others with a very considerable degree of deficiency as 
1 merely 'backward.' 

Thus, to cite only two cases : 'A' is a gentleman, twenty- 
eight years of age, who has spent five years in university 
work. He has been diagnosed as a 'moron,' as a 'degener- 



150 MENTAL HEALTH OF SCHOOL CHILD 

ate,' as 'a case of constitutional inferiority,' as 'a case with 
paranoid trends,' etc. According to the Binet tests he was 
clearly 'feeble-minded,' as he measured only 11.4 years in 
the 1908 series. Anyone knowing no more about the 
technique of psychological examination than the Binet- 
Simon scale would at once have classified him as 'feeble- 
minded,' but he did not impress me at all as being feeble- 
minded. His appearance, speech and conduct suggested 
the polished and cultured gentleman. Accordingly, I put 
him through approximately thirty sets of mental tests 
(other than twenty-five individual Binet tests) and thirty 
moral tests. These tests demonstrated that there was a 
considerable difference in the strength of his different 
mental traits. Some traits were on the twelve-year plane, 
some on the fifteen-year, some on the sixteen-year, and 
some on the adult plane. In some mental tests he did 
as well as college men. He passed correctly practically 
all of the moral tests. Here is a case showing more or less 
deficiency in respect to various mental traits ; but the man 
lis not feeble-minded, contrary to the Binet rating (a 
sexual complex was at the root of his trouble). 

'B' is an attractive girl of considerable culture, age 
seventeen, studying Latin, history, algebra and EngHsh in 
the tenth grade of a private school. She entered school 
at the age of seven, but has attended rather irregularly 
because of precarious health. Her school work is not very 
satisfactory. The most marked mental defect noticed by 
her teacher is her forgetfulness. By the Binet tests she 
would be rated as 'feeble-minded,' since she graded only 
11.4 years. But no one but a psychological tyro or a 
mere Binet tester would so classify her. (Her condition 
borders on psychasthenia.) 

While intelligence defect is the most obvious trait of 



THE PSYCHOLOGICAL CLINIC 151 

feeble-mindedness, there are other clinical and develop- 
mental phases which must be taken into consideration 
before a positive diagnosis can be pronounced in many 
cases. It is a hazardous and unscientific procedure to per- 
mit amateurs to brand children as 'feeble-minded' solely 
because they show a considerable degree of intelligence re- 
tardation ; it is a serious matter always to classify any child 
as 'feeble-minded.' Parents ought to have a right to de- 
mand an independent examination by a competent psycho- 
educational speciahst before a child can be placed in a 
special class. In London, parents, by statutory right, may 
demand an examination of children placed in special classes 
every six months. The London County Council has 
recently appointed an expert psychologist to mentally 
examine school children. In Paris, a special examination 
for mentally defective children is enjoined by law. But 
this examination, at least the final diagnosis, should be 
made by a specialist whose verdict is authoritative. It is 
certain that parents will be far more ready to accept a 
mental diagnosis if it is made by a competent psychologi- 
cal expert. In some cities considerable friction has arisen 
because parents and teachers have not always been willing 
to accept the diagnosis of feeble-mindedness made by teach- 
ers, nurses or physicians who are amateurs in psychologi- 
cal work. As already stated, learning how to give a few 
tests is no substitute for a prolonged course in psycho- 
clinical diagnosis. Mere tests, whether in psychology or 
medicine, are not always conclusive. Even positive or 
negative serum reactions sometimes prove nothing. The 
psychologist, just Hke the physician, must base his diag- 
nosis on both laboratory and clinical studies. The tests 
used by the trained psycho-clinicist are invaluable in that 
they enable him to arrive at a more accurate clinical pic- 



152 MENTAL HEALTH OF SCHOOL CHILD 

ture of the mental condition of his case. But once the men- 
tal condition has been determined, there remains the more 
difficult task of locating the causes of the trouble and pre- 
scribing a differential treatment for each case. The accu- 
rate determination of the causation can only be made by 
investigating the personal and family history of the case; 
the hereditary factors, birth condition, record of diseases, 
physical and mental development, school history, mental 
habits, social heredity, environments and present physical 
and mental condition. In order to secure all the desired 
data, the psycho-clinicist should be able to command the 
services of social workers, nurses, medical specialist,^^ 
trained helpers to assist in some of the formal testing and 
record and filing clerks. Some of the university psycho- 
educational clinics have a physician on their staff; others, 
have a staff of consulting physicians in the medical school 
or affiliated hospitals or dispensaries. 

To repeat: the first function of the psychological clinic 
is to make an accurate diagnosis of mentally deviating 
children, in order to give expert advice in regard to the 
child's mental hygiene (and in regard to the physical 
treatment in so far as this is orthophrenic in its bearings) 
and educational care and training. 

II. The second purpose of the psychological clinic is to 
serve as a clearing house for mentally exceptional cases. 
The psychological clinic has no special interest in cases 
which are not mentally or pedagogically exceptional or 
abnormal. Moreover, its interests thus far have been 
largely, if not entirely, restricted to juvenile cases. The 
psychiatric clinic, on the other hand, deals more largely 
with adult than juvenile cases; and technically these cases 
are psychotic or incipiently psychotic in character. The 
psychological {i.e., the psycho-educational) clinic aims to 



THE PSYCHOLOGICAL CLINIC 153 

serve as a focal point where the data bearing on mentally 
and educationally exceptional children may be brought 
together for careful analysis and collation, and where 
the cases may be finally disposed of — some to institutions, 
some to special classes, some to hospitals or medical clinics 
or private practitioners and some to special courses of 
corrective pedagogics. Some psychological chnics also 
conduct medico-pedagogical schools. They conduct classes 
during the regular or summer terms and offer special work 
in corrective pedagogics (particularly in speech training). 
Many of the psychological clinics in this country which 
are properly organized have become clearing houses of 
this character for juvenile cases in the schools and courts. 
Thus in Seattle the university psycho-clinicist is also the 
consulting psychologist to the public schools and the 
juvenile court. He also spends part of his time examining 
cases throughout the state. In Minneapolis the university 
psychologists are doing work both for the public schools 
and for the juvenile court. Here the juvenile court has a 
room equipped for the examination work in the court 
house. In New Haven the Yale clinical psychologist, who 
is in the department of education, but who has his labora- 
tory in the medical school, does what psycho-clinical work 
there is done in the city. In Baltimore the study of men- 
tally abnormal children is undertaken by the clinical psy- 
chologist, who is (or was until his death) connected with 
the Phipps Psychiatric Clinic. The University of Kansas 
examines cases at Lawrence and elsewhere in the state. 
The clinic in the State University of Iowa also aims to do 
state-wide work. The clinic in the School of Education, 
University of Pittsburgh, is examining cases not only from 
Pittsburgh, but also from the surrounding towns and 
country. 



154 MENTAL HEALTH OF SCHOOL CHILD 

III. The third function of the psycho-clinicist is re- 
search, particularly with a view to increasing and perfect- 
ing diagnostic tests and to extending our knowledge of 
the nature, causes and treatment of mental abnormalities. 
Owing to our ignorance in this field, the need for systematic 
research is paramount. 

IV. A fourth function of the psycho-clinic comprises 
education and propaganda — the dissemination of reliable 
information and knowledge regarding the condition and 
needs of the mentally abnormal classes. This is done 
through the offering of lecture and clinical courses, the 
publication of memoirs and investigations, the conducting 
of demonstration clinics, etc. There is constant need, e.g., 
to develop a sympathetic and enlightened public opinion 
in regard to the needs of the unreached children in the 
public schools, in order that they may be properly classified 
and segregated, so that they may receive the pedagogical 
training which befits their peculiarities. There is need for 
enlightened pubhc agitation right here in Pittsburgh, to 
the end that facilities may be provided for the large army 
of subnormal school children in our public schools. Over 
10 per cent of all the elementary pupils in the Pittsburgh 
public schools are retarded three years or more. It is safe 
to say that one-half of this 10 per cent or about 3,000 
pupils should be in 'special' classes instead of in the regu- 
lar, 'ungraded,' anemic or tubercular classes. And yet 
Pittsburgh today does not have a single special class in 
which differentiated training is provided for feeble-minded 
and backward cliildren. It is the one city of its class in 
the United States without special classes for these chil- 
dren.* In March, 1911, there were 319 cities in the country 

4 One special class was started during the school year 1913-1914. 



THE PSYCHOLOGICAL CLINIC 155 

which had estabhshed classes for 'mentally defective' and 
'backward' children (the former including epileptic classes 
and the latter those in which 'special teachers are employed 
to assist slow pupils'). This is an entirely new phase of 
educational work in Pittsburgh, where it must be organized 
from the very beginning. (See note following Chapter 
XIX.) 



CHAPTER V 

THE DISTINCTIVE CONTRIBUTION OF THE 

PSYCHO-EDUCATIONAL CLINIC TO THE 

SCHOOL HYGIENE MOVEMENT' 

It is only in the twentieth century that we have come 
to recognize that the conservation of school children 
involves more than inspection for physical diseases and 
defects, more than medical treatment and physical hygiene, 
more than the provision of school lunches, sanitary drink- 
ing fountains, schoolhouses properly regulated in regard 
to temperature, fresh air and humidity, open-air classes 
for the tubercular and anemic and special classes for the 
crippled, deaf and blind. It is only within the last few 
years that the laity, and also very many of the experts, 
have so much as suspected that there is a realm of mental 
orthogenesis (or ortho phrenic s) independent of, although 
supplementary to, the realm of physical orthogenesis (to 
which I have previously applied the term orthosomatics) ; 
that there is a psycho-educational type of school inspec- 
tion entirely different from physical, medical or dental 
inspection ; and that there is a sphere of corrective peda- 
gogics and psycho-educational therapeutics paralleling 
the sphere of dento-medical care and the surgical removal 
or correction of physical handicaps. 

1 Delivered before the session on Mental Hygiene and the Hygiene 
of the Mentally Abnormal Child, at the Fourth International Con- 
gress on School Hygiene, Buffalo, August 37, 1913. 



THE PSYCHO-EDUCATIONAL CLINIC 157 

How loath the human mind is to recognize or sanction 
new movements may be best indicated by the fact that 
while this International Congress has a section devoted to 
school inspection (or health supervision), it appears from 
the announcements that the connotation of the words 
'school inspection' is confined to physical inspection (medi- 
cal and dental), although numerous theses^ have been pre- 
sented in the public prints during a number of years to 
show that there is a psycho-educational type of inspection 
radically different from dento-medical inspection, and 
although this type of inspection is now an accomplished 
fact in many of the leading centers of educational endeavor 
throughout the country (see Chapters II and XVIII). It 
is evident, therefore, that we must extend the connotation 
of the term 'school inspection' so that it will include three 
distinct phases : medical, dental and psycho-educational. 

The clinical psycho-educationist performs certain func- 
tions which no other specialist had previously been trained 
to perform. The pedagogue, even though he be amply 
trained, was merely prepared to instruct, educate and 
discipline children, but had no qualifications for making 
anything but the crudest psychological and educational 
diagnoses. He was in no sense a clinicist. The pediatri- 
cian knew much about the physical diseases of young chil- 
dren and a good deal about the diseases of older children ; 
but his knowledge of children's mental and educational 

2 Thus articles written by the author in 1909 (Medical and Psy- 
chological Inspection of School Children, The American School 
Master, p. 435), in 1911 (The New Clinical Psychology and the 
Psycho-Clinicist, Journal of Educational Psychology, p. 121, 191) 
and in 1913 (Clinical Psychology: What It Is and What It Is Not, 
Science, p. 895; The Functions of the Psychological Clinic, Medical 
Record, September; Re-averments Respecting Psycho-Clinical Norms 
and Scales of Development, Psychological Clinic, p. 89). 



158 MENTAL HEALTH OF SCHOOL CHILD 

deviations was limited to the merest generalities, and his 
knowledge of the examination technique of the psychologi- 
cal laboratory and of educational methodology and cor- 
rective pedagogy was extremely meager or practically nil. 
The neurologists and psycho pathologists were versed in 
the nervous disorders of children and adults, and they 
knew a good deal about the phenomena of disordered or 
alienated mentality ; but they knew far less about the minor 
forms of mental and pedagogical variation which more 
frequently occur in exceptional school children, and they 
had made little, if any, technical study of educational, 
experimental and clinical psychology, of child study, of 
the principles of teaching and of the differential pedagogic 
treatment required by each type of mentally deviating 
child. Likewise the ordinary psychological expert knew a 
good deal about experimental and physiological psychol- 
ogy and more or less about educational psychology and 
child study ; but usually he had no professional training in 
elementary methods or special pedagogics, he had no 
training in clinical technique and he lacked that first-hand 
experience with cases which is essential in order to become 
skilled in diagnosis. 

Here, then, was a field of diagnosis for which the exist- 
ing types of specialists, whether medical, psychological or 
educational, had practically no scientific preparation 
whatever. But this gap, the existence of which is now 
quite obvious to the intelligent observer, is being rapidly 
filled by the development of psychological or psycho- 
educational clinics. To America belongs the chief honor 
for constructive achievement in this field of applied psy- 
chology. In America we are rapidly developing a new 
type of psychologist or educationist trained in psycho- 
educational diagnosis and orthogenesis. 



THE PSYCHO-EDUCATIONAL CLINIC 159 

Y With the rapid multiphcation of the psychological 
clinics during the last few years, there has developed a feel- 
ing in the medical profession that the clinical psychologist 
is encroaching upon a field preempted by, and held sacred 
to, the physician. This fear, however, is entirely without 
foundation. The work of the clinical psychologist {i.e., 
the psycho-educational clinicist) and the medical man are 
not competitive or duplicative, but supplementary and 
correlative. To be sure, the clinical psychologist (psycho- 
educational clinicist) wants his cases medically and den- 
tally examined in order that he may more accurately inter- 
pret his findings, but he leaves this work to the medical 
and dental specialists. If his clinic is well endowed, he will 
have a medical specialist or a number of medical specialists 
on his staff; otherwise he will utilize medical consultants 
from the dispensaries, hospitals and medical schools. The I 
educational clinicist seeks all the medical data available on 
his cases precisely as he seeks all the sociological, heredi- 
tary, pedagogical, psychological and anthropometric facts 
that he can secure. But all these data are merely contri- 
butory to his chief purpose: the interpretation of the 
mental and educational peculiarities, abnormalities, reduc- 
tions or intensifications revealed by his psychological and 
educational tests and analyses. And the purpose of an 
accurate interpretation of the psychological and educa- 
tional symptoms is, in turn, to enable him to prescribe 
appropriate orthogenic treatment. This may consist 
in giving advice to the parent or teacher regarding 
the proper mental hygiene of the child and regarding its 
proper educational classification and pedagogical train- 
ing, or it may consist in referring the case to the dispen- 
sary, hospital or a private practitioner for medical, dental 
or surgical care. In any case, the function of the psycho- 



160 MENTAL HEALTH OF SCHOOL CHILD 

educational clinic is distinctly orthophrenic ; namely, the 
righting or correction of the mental functions which are 
deviating or abnormal, either by the removal of physical 
handicaps or by proper mental and educational treatment ; 
the stimulation by appropriate stimuli of functions which 
are slowed down or retarded, and the placing of the child 
in the right educational classification or environment, so 
that he may attain with the least expenditure of energy 
and the least amount of friction to his maximal potential. 

The clinic strives to determine what are the inherent 
mental and educational peculiarities and what the inherent 
strength of various mental functions in the child ; whether 
he is only apparently or genuinely abnormal, subnormal 
or supernormal ; in which mental planes he is deficient and 
in which functions he is talented. But always the purpose 
of this detailed psycho-educational analysis is to furnish 
that insight which will enable the psychologist to place 
his case in the right place in the educational system, or to 
so adjust the educative materials and methods that they 
will minister effectively to the child's peculiar needs. 

From what I have said, it is evident that the interest of 
the psycho-educational clinicist is in children who are 
mentally and educationally unusual and who can be helped 
by special psychological or educational treatment. This 
group includes, among other types, supernormal, bright, 
backward, feeble-minded, epileptic, psychasthenic, neu- 
rotic, speech-defective and morally and emotionally 
unstable children. 

At the University of Pittsburgh we are conducting a 
free dispensary psycho-educational clinic, to which the 
above and other types of children, including child prodi- 
gies, children with alexia, agraphia and motor defects but 
without corresponding intellectual impairment, have been 



THE PSYCHO-EDUCATIONAL CLINIC 161 

brought by parents, teachers, nurses, physicians and social 
and settlement workers. Of a limited number of consecu- 
tive examinees (the first 184 who were thoroughly exam- 
ined) which I have tabulated, 11 per cent were classified as 
bright or supernormal, 11 per cent as normal and 77.9 
per cent as subnormal. Most of the subnormals were back- 
ward; namely, 39.2 per cent of the entire number examined. 
Seventeen per cent of all the cases were classified as feeble- 
minded, 11.6 per cent as border cases and 9.9 per cent as 
merely retarded. Eight and eight-tenths per cent were 
classified as morons, 6.6 per cent as imbeciles and .5 per 
cent as idiots. While very few of the feeble-minded 
belonged to any special type, there were two Mongolians, 
one cretin, one paralytic and one case of infantilism. The 
average amount of time devoted to the study of these cases 
was about one and one-half hours, while the maximum time 
given to any one case was over twenty hours. This case 
had been variously and fallaciously diagnosed as a moron, 
a moral imbecile, a degenerate and a mild paranoiac, but 
the mental factors which were found to be responsible for 
his abnormal behavior pointed to an entirely different 
diagnosis. 

Some of the advice which had been given to parents 
concerning many of these cases would be termed ludicrous, 
were it not that it was actually tragic. Parents had been 
told by so-called experts, 'not to bother about their child 
as he was all right ; not to worry, because the child would 
outgrow his trouble when he attained the age of six or 
seven, or thirteen or fourteen.' In consequence practically 
all of these cases, which proved to be utterly hopeless so 
far as concerns restoration to normality, had been educa- 
tionally neglected for years. They had wasted their child- 
hood in the regular grades in the vain endeavor to do work 



162 MENTAL HEALTH OF SCHOOL CHILD 

for which they were utterly unfitted. Because of their 
inability to advance they had either been neglected in 
despair by the teachers or they had unduly monopolized 
the teacher's time and robbed the normal pupils of the 
attention which by right was theirs, or they had been pro- 
moted irrespective of their deserts merely to relieve the 
room of an intolerable burden. The crime was not the 
pupil's or the teacher's, but society's. Society still com- 
placently tolerates many a school system which utterly 
lacks the requisite machinery for the scientific psycho- 
educational classification of its educationally exceptional 
children, but it also must be conceded that one of the 
stumbling-blocks to progess in work with mentally abnor- 
mal children is the schools themselves. During the past 
year I have had the interesting experience of having 
several teachers report to me that they wanted to send 
cases to the clinic for examination, but the principals 
refused permission. The principals said: 'The children 
are all right ; we will leave well enough alone, and proceed 
as we have done before. The fault is not with the children 
but with the inefficient teachers.' 

And now an interesting point is this : two parents 
brought me two cases which the principal had refused to 
send. Both of these children proved to he imbeciles. And 
yet the omniscient principal had said that they were all 
right and that the fault was the teacher's. As a general 
proposition the teachers who work daily with the pupils 
can gauge their mentahty more accurately than many 
principals or superintendents. 

The moral of my story is simply this : just as the schools 
now pedagogically examine children as a matter of course, 
of legal right and of routine, in order properly to grade 
and promote them, so must the schools as a matter of legal 



THE PSYCHO-EDUCATIONAL CLINIC 163 

right and as a matter of fixed routine, psychologically 
examine all mentally unusual children, so that they may 
be more accurately mentally and educationally classified 
and diagnosed. Only thus can we economically and scien- 
tifically train all the children of all the people. Every 
large school system should employ a psycho-educational 
specialist who is as thoroughly trained in this work as the 
best medical, neurological or psychiatric specialists are 
trained in their work. 

Discussion following the reading of the above paper. 

In answer to Dr. Ira S. Wile's remarks : 

Under ideal conditions we ought to subject every school 
child to a psycho-educational examination at the time that 
it enters school for the first time, and periodically there- 
after in case it does not develop normally. But I do not 
advocate this in practice, because to carry out such a 
program of work would require larger staffs of experts 
than the taxpayers will be ready to support. I do say, 
however, that every child who is retarded not more than 
two years in his school work, and every child who is obvi- 
ously or even apparently mentally peculiar or abnormal, 
should be given a special psycho-educational examination, 
in addition to the regular dento-medical examinations 
which are now regularly given in all large school systems. 

The methods and aims of a psycho-educational examina- 
tion are not the same as those of a medical examination. 
The psycho-educational clinic, while closely related to, is 
not identical with, the neurological or psychopathic clinic. 
I should say that the average physician would require 
three or four years of technical training in order to be able 
to learn skillfully to psychologically and educationally 



164 MENTAL HEALTH OF SCHOOL CHILD 

examine a mentally unusual child and skillfully to direct 
his educational development, just as I should say that it 
would require a similar period of time for the average 
psychologist to fully qualify himself to examine children 
medically (as well as psychologically), I do not think 
we shall soon reach the point where either the medical men 
or the psychologists (or the clinical educationists) will be 
ready to spend three or four extra years of prescribed 
study, in order to qualify themselves as double examiners 
(medical and educational). Therefore, I maintain that 
we need, as a minimum, two types of specialists for the 
work of examining and directing the care and training of 
mentally exceptional children; an educational specialist 
thoroughly trained in the art of psycho-educational diag- 
nosis and in the differential, corrective pedagogics apper- 
taining to the different types of educationally exceptional 
children ; and a medical man who has had special prepara- 
tion in the art of detecting physical defects and in pedi- 
atrics, neurology and psychiatry. The problems concern- 
ing the diagnosis, care, training and education of the many 
types of mentally and educationally exceptional children 
are so varied and complex that one type of specialist very 
probably cannot develop sufficient skill to satisfactorily 
handle them all. 

In answer to the question: What do you do for your 
cases after you have examined them? 

That depends entirely on the results of the examination. 
There is no specific of universal applicability. There are, 
indeed, certain cases which can profitably be subjected to 
the same educative processes, but many cases require dif- 
ferentiated educational treatment. In the case of a peda- 
gogically retarded child who rates normal mentally and 
whose school retardation is due to adventitious factors 



THE PSYCHO-EDUCATIONAL CLINIC 165 

(frequent transfer from school to school, absence because 
of illness, disinterest, etc.), I should not prescribe a special 
curriculum of corrective work, but more individual atten- 
tion. His is a problem for the 'ungraded teacher,' and 
not for the special class teacher. On the other hand, 
speech-defectives, the feeble-minded, children weak in 
spelling or reading, etc., require special courses of correc- 
tive exercises. Moreover, every peculiar case should be 
carefully followed and subjected to later examinations so 
that the treatment may be modified to meet individual 
developmental needs. 



CHAPTER VI 

HUMAN EFFICIENCY^ 

A Plan for the Observational, Clinical and Experi- 
mental Study of the Personal, Social, Indus- 
trial, School and Intellectual Efficiencies of 
Normal and Abnormal Individuals 

The questions of first importance in the study of mental 
defectives are the questions of etiology, medical treatment, 
educational training and guidance and criminal responsi- 
bility. Etiology naturally claims a large share of con- 
sideration, because it is only after the etiological factors or 
agents of different abnormalities have been precisely deter- 
mined, that we are in a position to prescribe effective 
remedial and prophylactic treatment, or to deal success- 
fully with the educational problems affecting defectives. 

The criminal and legal aspects likewise deserve a large 
measure of attention. Various forms of mental (and pos- 
sibly anthropometric) abnormality predispose toward 
criminahty. It is of vital social importance to determine 
what types or classes of defectives lack moral insight and 
appreciation of moral values, the ability to distinguish 
between right and wrong, or truth and error, the power of 
self-control, and the feelings of shame, obligation and 
guilt. What classes of defectives are incapable of living 
in a normal human environment? How do criminalistic 

1 Read, in part, before the New York Branch of the American 
Psychological Association, February 4, 1911. 

Reprinted from the Pedagogical Seminary, 1911, pp. 74-84. 



HUMAN EFFICIENCY 167 

tendencies and moral discernment vary with degree of 
defect, type of disease {e.g., delusional insanities, epileptic 
manias), duration of disease, transitory states (well known 
are the occasional or transitory states of moral irresponsi- 
bility in some forms of epilepsy and in delusional and 
manic-depressive forms of insanity, which show themselves 
in maniacal outbursts, and kleptomaniac, suicidal and 
homicidal tendencies) and environmental conditions? The 
obligation of the state properly to protect the lives of its 
subjects, renders the study of questions affecting the moral 
responsibility of various kinds of defectives of fundamental 
social importance. The solution of the practical educa- 
tional, custodial and legal problems concerning defectives 
will hinge largely upon the answers which scientific investi- 
gation gives to questions of this nature. 

While the medical and legal questions are thus of great 
importance, it is also important to secure accurate knowl- 
edge concerning the personal, social, industrial, school and 
intellectual capacities and incapacities of various grades 
and classes of defectives, such as idiots, imbeciles, morons, 
laggards, epileptics and insane, blind, deaf, mute and 
crippled persons. There are thus five sides to the question 
of efficiency. 

First of all, what is the personal efficiency of a given 
grade or class of defectives .f* What can the individual do 
for his own care and protection? Can he feed and clothe 
himself, avoid dangers and temptations, control the primal 
instincts of appetite, sex, love, hate, anger, fear, jealousy, 
pugnacity, etc.? Where does he stand in the personal 
efficiency scale? What is the amount of his personal effi- 
ciency retardation, as measured in tenns of the personal 
capacities of a normal person of the same age? The 
answers to these questions involve the establishment of age- 



168 MENTAL HEALTH OF SCHOOL CHILD 

norms of personal efficiency — a task that probably cannot 
be done with any nicety except for the first years of Hfe, 

In the second place, what is the nature of the social 
capacities or incapacities of a given defective, or a typical 
defective of a given class? Is the individual able to com- 
municate his ideas or desires through written or oral lan- 
guage or through cries or gestures? Can he converse 
coherently or intelligently? Does he seek or avoid social 
intercourse, conversation, entertainments, games, etc.? Is 
he socially-minded or anti-social? Is he chummy, enter- 
taining, generous, sympathetic, timid, retiring, fretful, 
suspicious, deceitful, quarrelsome, slanderous, brutal, 
murderous, lascivious, sexually immoral, subject to exhi- 
bitionism or negativism, lying, thieving, etc.? Does he fit 
into the social organism? Can he so adjust himself to the 
customs and rules of society that he will not become a 
public menace? In short, what is the character of the 
individual's social deviation? What is his social efficiency 
age? Is he on the level of the morally undiscerning civi- 
lized young child or in the stage of the brutal adult 
savage ? 

In the third place, what is the industrial and vocational, 
or motor, efficiency of various defectives? What kinds of 
work can they do, and how well? How much can they do 
for their own support? What particular capacities are 
present or lacking? What special existent occupational 
interests may be utilized? What is the individual's atti- 
tude toward work and toward supervision and correction? 
What are his learning capacities? What working habits 
can he form? What new tasks can he master? To what 
extent are his industrial capacities improvable by training? 
What is his best Hne of work? How does his industrial 
efficiency vary from time to time? (Witness the striking 



HUMAN EFFICIENCY 169 

variations in epileptics.) What is the productive capacity 
of a given defective in comparison with a normal person 
of like maturity, and to what extent can the productive 
capacity be increased? In a word, what is the amount of 
the motor or industrial defect, or what is the motor and 
industrial age, of a given defective? These questions 
demand solution before the pedagogy of the industrial and 
vocational training of defectives can be placed upon a 
satisfactory basis, and before the labor of the patients in 
institutions for defectives can be so organized as to afford 
maximal returns. 

In the fourth place, what is the nature of the academic 
or school capacities of different grades and classes of 
defectives? What sort of lessons can be mastered? In 
which branches do they make progress? Which subjects 
are worth teaching? What methods must be employed to 
obtain maximal results? How does the rate of progress 
differ from the normal rate (the rate with normals)? 
What is the precise rate and character of the improve- 
ment from month to month or year to year, as measured 
by scientifically devised serial tests of equal difficulty, of 
those mental functions which are central in the learning 
process ; namely, perception, attention, association, mem- 
ory, imagination, linguistic construction and reasoning? 
What kinds of improvement prove to be permanent, what 
merely transitory? What are the special difficulties of a 
given defective? What are his native or acquired inter- 
ests, attitudes, ability to observe, judge, reason, form 
habits, adapt himself to changed schedules and new condi- 
tions, to learn by instruction, or imitation, or hit-and- 
miss experimentation, or repetition (drill processes), or 
reasoning? How many years over-age is the child for his 
grade? That is, what are the nature and extent of his 



170 MENTAL HEALTH OF SCHOOL CHILD 

pedagogical retardation? What is his pedagogical age? 
We cannot hope to adapt our curricula to the varying 
needs of defective children until we have thrown the search- 
light upon these vital school problems. 

Finally, we have the basal question of the character of 
the intellectual disorganization and the degree of the 
intellectual arrest of various defectives. This question is 
fundamental, because all the other capacities depend more 
upon the intellectual integrity of the individual than upon 
the integrity of any other group of functions. Here we 
must ascertain, not so much the range of the individual's 
information or his erudition, as the degree and character 
of his native and acquired intellectual grasp, capacity or 
ability. Is his intellectual development normal, or has it 
been arrested from the start, or has it become atrophied 
with time.f* What particular intellectual functions have 
suffered the greatest impairment ? Where along the intel- 
lectual highway from the low-grade idiot up through the 
imbecile, moron and laggard to the normal person, has the 
individual stopped? What, in a word, is the individual's 
intellectual age? Can this be determined in definite units, 
or by diagnostic age tests, more precisely than can be 
done by observation or by the use of school grades ^ 

The above are fundamental questions which must be 
properly answered before we can presume to deal intelli- 
gently with the problems affecting the housing, segrega- 
tion, care, treatment and education of public school and 
institutional types of defectives, or before we can deal 
intelligently with normal and supernormal children. 

At the New Jersey State Village for Epileptics^ it was 

2 A laboratory of clinical psychology was established by the Board 
of Managers at this institution in October, 1910, under the director- 
ship of the writer. 



HUMAN EFFICIENCY 171 

my privilege recently to inaugurate investigations of the 
above questions by observational, clinical and experimental 
methods, and to prepare a series of record blanks on wliich 
to record the data. These forms are uniform in size 
with the other forms in use in the institution and are so 
made that they can be gathered into book form and thus 
provide a case history for each patient. 

In order to determine the patient's intellectual status we 
have been giving the form-hoard test, which throws light 
upon the patient's ability to visually identify forms, upon 
his constructive capacity and his power of muscular co- 
ordination; the hand dynaTnometry test, which roughly 
tests the power of voluntary attention and effort, and par- 
ticularly the power of muscular exertion ; the Binet-Simon 
tests of intellectual development (all of the above are on 
Form I) ; and a set of six serial or consecutive controlled 
group tests {Form V^). The latter tests were given 
serially (one set each month) to somewhat over thirty of 
our brightest epileptic school children, and to somewhat 
less than 100 dull, average and bright pupils from the 
second to the third high-school grades in a nearby public 
school. Owing to our late start, and the writer's removal 
from the institution, these tests could be given only during 
five months ; it would have been better to have given them 
once every second month during the course of the entire 
year. These group measurements embrace tests of various 
mental processes fundamental to intellectual operations : 
accuracy of perception, perceptual discrimination, obser- 

3 Four of the forms were distributed at the meeting. Form I also 
contains a number of miscellaneous tests; Form II deals with the 
'effect of convulsions on mental traits and capacities'; Form III is a 
'personal, social and industrial efficiency report'; Form IV is a 'school 
efficiency report'; and on Form V is recorded 'serial experimental 
tests of the growth and improvement of mental traits and capacities.' 



172 MENTAL HEALTH OF SCHOOL CHILD 

vation and reaction; the capacity to memorize and the 
power of immediate and prolonged retention ; the rate of 
forming spontaneous associations with determinate ante- 
cedents, the ability to form such controlled associations as 
are involved in adding columns of ten one-place digits and 
supplying antonyms to a set of simple words ; the ability to 
retain a list of logical and illogical sequents with determi- 
nate antecedents from one reading by the experimenter, 
during a period of a couple of minutes and during a 
period of four weeks ; the capacity for visual imagination ; 
and the capacity for linguistic construction as evidenced 
by the ability to construct a maximal number of sentences 
each of which must contain three suppKed nouns or verbs. 
The aim has been to make each of the six successive tests 
in the same series different but at the same time equally 
difficult, and all so difficult that no one can make a perfect 
score, so that they may serve as an experimental measuring 
scale of the growth and improvement which various mental 
capacities or traits undergo from month to month or year 
to year as a result of normal maturation, education, train- 
ing, familiarity, removal of physical defects, proper regu- 
lation of temperature and humidity, or abstention from 
tobacco or alcohol. By giving these tests to many normal 
children from season to season or year to year it is possible 
to establish normal rate norms of development for the 
traits tested, by which to measure individual retardations 
or accelerations, as well as the differences in the capacities 
of various classes of children (normal, bright, dull, back- 
ward, epileptic, feeble-minded) . Several of these tests were 
originally prepared for use with a 'dental squad' of Cleve- 
land school children receiving special prophylactic and 
operative dental treatment, in order to measure in definite 
units the effects of such treatment upon mental efficiency. 



HUMAN EFFICIENCY 173 

The use of these tests for this purpose gave very gratify- 
ing results. The twelve tests which I have worked out — 
two are repeated during the following sitting in such a 
way as to transform them into new tests — may not afford 
the best measuring scales, but they furnish an initial set 
which can be altered and improved as experience demands. 
The materials for these tests, together with the directions 
for giving them, may be secured from the C. H. Stoelting 
Co., Chicago, 111. The results of the experiment have 
been tabulated, but have not yet appeared in print. 

The Binet-Simon measuring scale, with which I have 
made a survey of the entire village, enables us to make a 
fairly satisfactory determination of the degree of intel- 
lectual arrest of the patients, although the tests are faulty 
in various particulars (see Chapters IV, VIII, IX, X). 
Here it may be pointed out that the aggregate difficulty of 
the tests for a given age may be greater than that for a 
higher age ; some tests are of questionable utility, notably 
those for the higher ages ; the tests need to be extended so 
as to include more of the teens, and this is more difficult 
because in the teens one year makes less diiFerence in intel- 
ligence than one year during the early years of childliood. 
Moreover, it is not yet certain whether the scale is appli- 
cable to the higher grade adult dements or to slightly 
retarded adolescents (it seems to apply fairly well to most 
demented idiots, and particularly to amented idiots, 
imbeciles and low-grade morons) ; nor is it certain that the 
same tests are applicable to both boys and girls, except 
during the preadolescent period, owing to the difference in 
the physiological, psychological and pedagogical maturity 
of boys and girls of the same chronological age. 

After some tests have been repeated sufficiently often 
in a given school or locality to render them familiar, it is 



174 MENTAL HEALTH OF SCHOOL CHILD 

possible for the higher grade examinees to compare notes 
and coach one another. This has happened in my experi- 
ence both with pubhc school and high-grade institutional 
cases. This will enable some pupils to pass the tests 
beyond their intellectual age, and will transform the meas- 
uring scale into a series of tests of the ahility to learn par- 
ticular facts or to acquire particular accomplishments, by 
dint of direct instruction. But the tests are not designed to 
try the momentary capacity to acquire a determinate set 
of facts by special instruction, but to measure the capacity 
to solve certain problems without special preparation. 
They are intended to be a measuring rod of the intellectual 
capacity or strength which normal children of various ages 
and of a given type of civilization should have developed 
as a result of normal growth and development. They thus 
supply a series of age norms of native and acquired mental 
capacity ; not of native capacity only, as has been assumed. 
It would be fatuous to attempt to construct a scale for the 
measurement of pure native capacity, for pure native 
capacity, after the first few months of life, is a pure fig- 
ment of the imagination. Only by excluding the psychical 
and social environmental influences would there be any 
possibility of measuring native endowment independent of 
acquired capacity. A measuring scale will, therefore, 
measure both native and acquired capacity. Just as native 
capacity differs with individuals, so will the capacity to 
acquire diff^er with individuals ; but there is probably a 
certain rate of acquisition which is fairly normal in a 
given order of civilization, so that it will be possible to 
establish norms which hold for the great mass of average 
or typical individuals. 

Fortunately the difficulty of which we have just 
spoken, the possibility of being coached so as to pass 



HUMAN EFFICIENCY 175 

some tests, can be met by devising substitute or variant 
forms of equal difficulty for some of the tests. 

The basis of initial rating and the corrective formula or 
the method of giving advance credits (one year for every 
five points passed in higher ages) sometimes create diffi- 
culties. This is due to the fact that the number of tests in 
the various ages in the 1908 scale is not uniform, and to 
the fact that subjects may pass superior ages while failing 
on lower ones. In four ages in the 1908 scale the number 
of tests is four (ages four, five, ten and twelve) ; in two it is 
five (three and eleven) ; in two six (eight and nine) ; in one 
seven (age six) ; and in one eight (age seven). The con- 
sequence is that the subject sometimes receives too few and 
sometimes too many credits. To illustrate cases from my 
experience: if the subject passes age six by virtue of two 
failures in age seven, he can obtain one and one-fifth year 
of credit for age seven ; i.e., one-fifth of a year more credit 
than if he were credited outright as having passed age 
seven. If he fails on age six but passes age ten he can still 
be rated as ten years mentally. The maximum discrep- 
ancies which I have found arising from different bases of 
rating have amounted to over three years, wliile for 39 
per cent of 103 epileptic cases studied they amounted to 
one year or over. This difficulty, however, is not innate in 
the tests themselves, and can be overcome by equalizing 
the number of tests in each age, as has been done in the 
1911 revision, b}' rearranging the tests, or revising the 
corrective formula as may be needed. 

There are two methods by which to scientifically elimi- 
nate, revise, add or amplify tests in the Binet scale. First, 
by testing masses of physically and mentally normal public 
school children. But it is necessary to emphasize that the 
testing must be a thoroughgoing try-out. To examine five 



176 MENTAL HEALTH OF SCHOOL CHILD 

or six pupils in an hour at a given level in the scale, as has 
been done, means partial and perfunctory work, and will 
render the try-out essentially unscientific. We cannot 
hope to establish reliable norms for children by a slap-dash 
examination of wholesale quantities of pupils. It is better 
to try the scale out thoroughly with 1,000 pupils than 
partially with 10,000. 

A second way in which to improve the scale, is to under- 
take a systematic survey of the intellectual capacities of 
normal boys and girls at different ages. What, e.g., can 
the typical six-year-old or twelve-year-old boy or girl do 
intellectually.'^ To answer this question fully we need to 
gather and compile extensive observational data from 
classroom teachers, expert paidologists, parents and intel- 
ligent observers who come into direct daily contact with 
children. 

At the Skillman institution I initiated an attempt to 
gather such data for the epileptic school children by pre- 
paring a syllabus on the school efBciency of the pupils. 
School efficiency depends primarily upon intellectual capac- 
ity and thus furnishes an index of intelligence. From the 
reports, made by the teachers, it should be possible to gain 
information regarding the characteristic intellectual 
capacities of epileptics of various chronological and Binet- 
Simon ages and of various degrees of mental arrest. The 
information thus gathered should possess a unique value 
when brought into correlation with other reports and the 
various experimental tests. As soon as we have extensive 
data of this character for large masses of normal children, 
we shall not only know something definite regarding the 
intellectual capacities of children of different ages, but we 
shall have taken an important step toward the construction 
of an adequate measuring scale of intellectual develop- 



HUMAN EFFICIENCY 177 

ment. Such a program of work as this can only be carried 
to a successful conclusion by a properly organized and a 
well-manned department of clinical psychology, or bureau 
of research, in the public schools, in a university or in an 
endowed private research foundation. 

It is probably not necessary to hold a brief in this day 
for the necessity of undertaking such a survey as this. 
There is a vast army of repeaters in the schools which 
threaten to become a national menace. At the present 
time, our ignorance concerning, and our neglect of, the 
best care, treatment and education of arrested children, 
stand out as a national disgrace. We know little at 
present that is scientifically accurate regarding the degree 
or character of the physical and mental arrest of our 
repeaters. We do, therefore, stand in need of comprehen- 
sive serial graded tests of intelligence, so that we may 
determine, not only the intellectual age of deviating chil- 
dren, but the nature of the mental functions most seriously 
affected, and the character of the arrest (whether per- 
manent or temporary). It is sheer folly to spend millions 
of dollars trying to educate for an intellectual career 
children who are permanently retarded. There are in- 
stances on record where arrested pupils have made prac- 
tically no progress during a dozen years of schooling, or 
where they have actually retrogressed. We have with us 
nineteen-year-old epileptics who are doing second and third 
year work. We should be able to determine by means of a 
scientific diagnostic (intelligence) scale (aided always, of 
course, by comprehensive 'case-studies') whether a given 
subnormal is a custodial or institutional case, or a case 
for one of the special classes in the public schools (for 
retarded, blind, deaf, mute children, etc.). Binet has given 
us a 'first-aid-to-the-sick' device, just at the time that we 



178 MENTAL HEALTH OF SCHOOL CHILD 

are awakening to a realization of the magnitude of the 
problem of mental deficiency. 

While the intellectual measuring rod is fundamental, we 
stand in need of a tnotor or industrial scale of development, 
or a combined intellectual-motor scale. This need arises 
from the fact that a sixteen-year-old child chronologically 
may have a twelve-year-old intellect and a fourteen-year- 
old musculature. Such a child is fairly strong muscularly ; 
he is able to execute and coordinate his movements with 
skill ; he can perform quite complicated manual operations ; 
he can master fairly difficult industrial tasks ; he can retain 
motor acquisitions and form stable muscular habits. 
Although he may be accounted an intellectual laggard, he 
ranks quite high in motor capacity and manual dexterity — 
a fact which is being demonstrated day by day in the 
manual training and industrial classes in the pubHc 
schools. Such a child would, then, be fairly normal on the 
motor side. 

Since, therefore, the intellectual and the motor develop- 
ments will not in all cases coincide, we need a series of 
motor diagnostic tests arranged in a graded scale, in order 
that we may know what a normal girl and boy can do 
industrially, or in motor performance, at different ages. 
It should be possible to construct such a scale for, at least, 
the periods of childhood and early adolescence. Having 
both the intellectual and the motor scales, separate or com- 
bined, we shall be in a position to say whether the child's 
defects involve in equal measure the intellectual and the 
motor functions, or which of these two have suffered the 
most impairment, and to what extent the arrest has set in. 
The pedagogical value of such a differential diagnosis is 
obvious. Instead of allowing teachers to consume their 
energies and the energies of the pupils for years, trying by 



HUMAN EFFICIENCY 179 

some sort of intellectual legerdemain to fit round boys and 
girls into square holes, we shall be able to prognosticate 
by means of standard tests (together with accompanying 
exhaustive clinical studies) the probable future pedagogi- 
cal development of the arrested child, and thereby be able 
to plan a course in which he will make the greatest pro- 
gress. This will not only redound to the good of the child, 
but prevent much pedagogical blundering, loss of time and 
money, and vexation of spirit. 

Unfortunately there is no existent motor or industrial 
scale of development for normal children comparable with 
the Binet-Simon intellectual scale. At Skillman I had the 
pleasure of launching an attempt to construct such a scale 
for epileptics, by collecting extensive observational data 
from the officers, supervisors, attendants and employees of 
the institution, bearing upon the industrial capacities of 
the patients who are employed in various forms of indoor 
and outdoor work. From the results thus obtained it 
should be possible to construct a motor scale of develop- 
ment for epileptics for each Binet-Simon age. (Informa- 
tion is not now available as to whether these inquiries are 
still carried on.) It is evident that such a motor scale 
would possess greater value if we were in a position to turn, 
for purposes of comparison, to a motor scale for normal 
and supernormal individuals. The need of a normal 
industrial scale is felt as keenly by the student and trainer 
of the special cliild, whether subnormal or supernormal, in 
the public schools, as by the student and trainer of institu- 
tional types of defectives. Departments of child study in 
the public schools and research departments in institutions 
for defectives should make an attempt to gather extensive 
industrial or motor data by some such means as those we 
are now using. 



180 MENTAL HEALTH OF SCHOOL CHILD 

Finally, we must make a survey of the personal and 
social traits and capacities, the moral characteristics and 
criminal tendencies of our patients. The data on the per- 
sonal capacities will supply additional material for our 
comparative measuring scales. There is need of a similar 
systematic study particularly of the moral and criminal 
traits of the abnormal, mischievous and delinquent pupils 
who people our schools, and of the criminals who menace 
our civilization. These data should be secured, in the first 
instance, for the socially maladjusted child in the pre- 
adolescent years, before the criminalistic tendencies have 
become confirmed. Only when we have in our possession 
extensive facts of this character will we be in a position to 
place our pedagogical and moral training and prophy- 
laxis, and our custodial care and treatment of abnormal 
and criminal individuals upon a satisfactory basis. 

When we have given the same amount of careful, expert 
study to our normal and abnormal human population that 
the government is giving to the study of Indian corn or 
the American hog; when we have devoted the same scien- 
tific attention to the production of superb brain crops that 
experts, under government subsidy, are now giving to the 
growing of superior grain crops : then we may hope to 
make education a genuine science, and the school and insti- 
tutional training, care, treatment or penalization of defect- 
ives, dependents or criminals a real art. The view that 
public institutions, in addition to their recognized duties, 
should function as research laboratories, is rapidly gaining 
acceptance. Just now we stand in great need of extensive 
mass studies : a broad survey of the total field of human 
capacity. It is with this idea uppermost that the set of 
efficiency blanks at Skillman were prepared for the sys- 
tematic recording of observations. Our methods of inves- 



HIIMAN EFFICIENCY 181 

tigation must at present necessarily be somewhat crude. 
But in time we shall have just as refined a technique for 
studying the human animal as we now have for studying 
chickens and pigs. 



CHAPTER VII 

EIGHT MONTHS OF PSYCHO-CLINICAL RE- 
SEARCH AT THE NEW JERSEY STATE 
VILLAGE FOR EPILEPTICS, WITH SOME 
RESULTS FROM THE BINET- 
SIMON TESTING^ 

The functions of a clinical psychologist in an institu- 
tion for defectives, in a public school system, in a univer- 
sity, in a psychiatric institute or in a juvenile court is 
twofold: first, that of tJieoretical investigation, or the 
increase of knowledge under controlled and verifiable con- 
ditions. This is essentially the field of the research psy- 
chologist or of pure science, so-called. Second, that of 
practical application, or the utilization of the truths dis- 
covered for the educational, hygienic, medical and custodial 
treatment of the sufferers. This is the work of the con- 
sulting psychologist as distinguished from the pure re- 
searcher, and constitutes the sphere of orthogenesis, 
mental hygiene or applied clinical psychology. While the 
line of demarcation between these two aims should not be 

1 Read at the tenth annual meeting in St. Louis, Mo., of the 
National Association for the Study of Epilepsy and the Care and 
Treatment of Epileptics, and reprinted from the Transactions of 
the Association, 1911, pp. 29-43, and from Epilepsia (Amsterdam), 
1912, pp. 366-380. A volume of studies, based on my Binet-Simon 
testing of epileptics, will be found in Experimental Studies of Mental 
Defectives: A Critique of the Binet-Simon Tests, and a Contribution 
to the Psychology of Epilepsy, Warwick & York, Inc., Baltimore, 
1912. 



PSYCHO-CLINICAL RESEARCH 183 

made too fast and hard, logically the work of investigation 
in an infant science naturally takes chronological prece- 
dence to the work of consultation, as, indeed, science logi- 
cally precedes art. The art of righting defectives cannot 
rise above the empirical until it is based upon a foundation 
of assured facts. Until we thoroughly understand the dif- 
ferent types of nervous and mental abnormalities our 
treatment cannot be made maximally effective. For these 
reasons the work in the psycho-clinical laboratory at Skill- 
man during the past eight months has been devoted 
entirely to investigation. 

During these eight months a number of lines of investi- 
gation have been started, some of which have been con- 
cluded. Among the surveys of the village which have been 
completed (completed as far as testing each patient is 
concerned) are the following: Measurements of standing 
and sitting heights, of weight, of lung capacity, of the 
strength of right and left hand grip, of station or body 
sway, of the speed of performing the form-board test 
(replacing ten blocks of various forms in corresponding 
holes in a board), of intellectual capacity or the extent of 
intellectual retardation, as evinced by the Binet-Simon 
scale, and of the rate of growth and development, as well 
as the character and extent of the deviation or disorgani- 
zation of a number of particular mental traits and capaci- 
ties which play a basic role in mental development. The 
latter tests (described in Chapter VI) when given to 
normal children are intended to supply normal rate curves 
of mental development. 

The desirability, or even the feasibility, of establishing 
psychological rate norms of development has, strangely, 
scarcely dawned upon us until recently, although the prac- 
tical value of such norms is probably greater than the 



184 MENTAL HEALTH OF SCHOOL CHILD 

value of the corresponding anthropometric standards of 
yearly development during the growth-period of standing 
and sitting height, weight, chest perimetry, dynamometry 
and vital capacity. The importance of a set of anthropo- 
metric norms, arranged on the grade or percentile basis, 
has been eloquently set forth by the lamented Francis 
Galton, to whose comprehensive intellect many sciences 
have become indebted. Thanks to the labors of a few of 
Galton's followers, notably Bowditch, Porter and Smedley, 
and to the labors of the Italian anthropologists, we now 
possess a set of fairly reliable physical development norms 
and indices for certain ages, by means of which we are able 
to determine the physical station of a given child of a given 
age, and by means of which we can say whether his physical 
progress is normal or satisfactory as measured by the per- 
centile grade for the age to which he belongs (using height 
as the basis of comparison) , and by means of which we can 
determine the character of his anthropological indices. 
But we are now beginning to realize that we cannot prop- 
erly diagnose developmental defects of the mind until we 
have constructed a similar set of psychic norms of develop- 
ment of various traits and capacities. When we have such 
norms for specialized capacities we shall be able to locate 
the mental station of a given child at a given time, and 
determine whether his rate of mental evolution is normal 
for the grade in which he classifies. These norms will 
possess fundamental value for purposes of developmental 
diagnosis, in the study of not merely the lesser deviations 
but also the more profound mental abnormalities. To 
supply these mental developmental scales is chiefly a matter 
of time, labor and ingenuity ; the instrumental and techni- 
cal difficulties are secondary. Such scales will not, of 
course, attain the accuracy of refined physical measures, 



PSYCHO-CLINICAL RESEARCH 185 

but they will be far superior to our present 'common 
sense' judgments. The fair degree of success attained by 
the simple Binet-Simon tests of intelligence justifies the 
belief that this problem, baffling as it seems, is not insoluble. 
By means of the serial group tests which I have been giving 
during the past year, I am hoping to make some little 
addition to our knowledge in this largely unexplored, but 
inviting and important, field of inquiry. Aside from the 
value which the data from these tests will have for develop- 
mental diagnosis, the results may also be used as a means 
by which to check up the Binet-Simon tests, which have 
recently come into wide use in institutions for defectives 
and in the public schools in our country.^ I turn now 
to a consideration of some of the results of our Binet 
testing. The space at my disposal permits only a brief 
reference to a few of the more obvious facts, particularly 
those which concern the characteristics of the curve of 
distribution, or the classification of the epileptics at Skill- 
man by this method. 

Taking the gross or group classification, the 333 
patients^ included in the curve (Graph IV) classify as 

2 For other studies undertaken in the psycho-clinical laboratory 
at Skillman during the same year by means of the printed question- 
naire or syllabus method, see Chapter VI. 

3 Those epileptics were excluded from the tabulation who had not 
had a convulsion within a period of two years, and a few others 
who were not thoroughly tested because of certain sensory defects. 
The patients were in their normal condition during the tests. The 
grading in all cases is based upon the highest age passed, plus the 
advance credits provided for in the scale, irrespective of whether 
or not the patient failed at a lower level. Patients who passed in 
two of the thirteen-year tests were credited with this age, provided 
they also passed at least five tests in ages eleven and twelve. Draw- 
ing one triangle was accepted for the first of the thirteen-year-old 
tests. 



186 MENTAL HEALTH OF SCHOOL CHILD 

follows: 5.7 per cent are idiots (mentality of one and two 
years), 27.3 per cent are imbeciles (mentality of ages 
three to seven), 61.5 per cent are morons (mentality of 
ages eight to twelve), 5.4 per cent have a mentality of 
thirteen years or over (see the table and the curve), and 
82.8 per cent have a mentality of less than eleven years. 
The idiots and thirteen-year olds are about equally infre- 
quent, while the morons are decidedly preponderant. 
These results will attain a new significance if we compare 
them with the Binet curve for 378 feeble-minded inmates 
at Vineland.'* 

In this 19.2 per cent grade as idiots; 54 per cent as 
imbeciles ; 26 per cent as morons ; none as thirteen years 
of age; and 96.4 per cent less than eleven years of age. 
The feeble-minded idiots are about three and one-half times 
as numerous as the epileptic idiots, but the epileptic 
morons are more than two and one-half times as numerous 
as the feeble-minded morons. While the great mass of 
epileptic and feeble-minded defectives have a mentality of 
less than eleven years, the proportion is 13.6 per cent 
greater among the feeble-minded than among the epilep- 
tics. The typical epileptic category is that of the con- 
dition of moronity, which contains five-eighths of the 
entire number of the epileptics, while the typical feeble- 
minded station is that of imbecility, which includes more 
than one-half of the feeble-minded. It is apparent that 
there is a marked difference between epileptic degenerates 
and feeble-minded retardates in the matter of intelligence. 

4 GoDDARD. Journal of Psycho-Asthenics, 1910, 15 : Nos. 1 and 
2. The per cents for each age for the feeble-minded are as follows: 
Age I, 9.5 per cent; II, 9.7 per cent; III, 10.5 per cent; IV, 9.8 per 
cent; V, 11.1 per cent; VI, 10.2 per cent; VII, 12.4 per cent; VIII, 
11.6 per cent; IX, 7.9 per cent; X, 3.7 per cent; XI, 1.3 per cent; 
XII, 1.8 per cent. Age X in the curve is placed somewhat too high. 



Graph IV 

Classification of 333 epileptics (Skillman) and 378 feeble- 
minded (Vineland) by the Binet-Simon method. 



25 
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Per cent 


Per cent 


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The thirteen-year-olds may be classed as deviates, retard- 
ates or normals. 



188 MENTAL HEALTH OF SCHOOL CHILD 

The intellectual superiority of the epileptic defective is 
conspicuous. This superiority will attain added promi- 
nence if we constitute the thirteen-year-olds into a separate 
class above the feeble-minded line, which we may regard 
as normal, or as retarded or deviating but not sufficiently 
to render them feeble-minded. We should then have to add 
to this class all the children who are retarded less than 
three years (certainly many adolescent children retarded 
less than three years would not be feeble-minded). There 
are nine of these, five boys and four girls. These with 
the thirteen-year-olds, make a total of twenty-seven 
noi-mals, or deviates, which is 8.1 per cent of the entire 
group. ^ 

This figure we are justified, I believe, in regarding as 
a lower limiting value for two reasons. First, the tests in 
the higher ages are very probably too diflScult for the 
typical American child for the ages to which they are 
assigned. 

To get a line on these higher tests I made use of the 
following means. A few of the supervisors and officers at 
Skillman who had known the patients intimately for a con- 
siderable length of time were asked to prepare estimates 
of the number of patients whom they regarded as ranking 
above the feeble-minded station. Three made identical 
estimates, unknown to each other, for the total population, 
namely 10 per cent. Five men made separate and inde- 
pendent estimates of the total male population, as follows : 
11, 11, 13, 14 and 20 per cent. With one exception, these 
estimates agree fairly well. With the tests as at present 
constituted, it is a question whether the line of feehle- 

5 It is interesting to note, that among these twenty-seven there is 
only one who can be regarded as supernormal, a boy somewhat less 
than twelve years who grades as thirteen years. 



PSYCHO-CLINICAL RESEARCH 189 

mindedness shoidd be drawn (if indeed it can be definitely 
drawn anywhere) between twelve and thirteen, as has been 
tentatively done by the American Association for the 
Study of Feeble-Mindedness. A number of our twelve- 
year-olds are certainly very slightly, if at all, feeble- 
minded. 

A second reason why the percentage of normals may 
be too low is the fact that the institutional cases at Skill- 
man may not be representative. Our curve in general is 
valid on the assumption that the epileptics tested are 
typical. According to the theory of the probability sur- 
face we are justified in regarding them as typical if the 
selection represents a chance distribution. But it is possi- 
ble that two selective processes have operated in a way to 
distort both extremes of the curve. The reason that the 
idiots are so few may be due to the fact that the higher- 
grade epileptics have received preference in admission to 
the institution. The introduction of a constant factor of 
this sort would skew the frequency curve in the direction 
of the upper limit. This tendency would probably stop 
short, however, before it reached the extreme end of the 
curve, because it is likely that the highest grade of epilep- 
tics from the better social classes are very rarely found in 
public institutions. We shall not be able definitely to 
settle this point until other institutions have undertaken 
similar studies on a large scale. But three general con- 
clusions seem assured: first, that the great mass of epilep- 
tics fall below the feeble-minded line ; second, that they do 
not fall below this line to such an extent as the class of 
amented feeble-minded; and third, that the curve of dis- 
tribution is markedly different for the two classes. Just 
how much inferior the high-grade epileptics are to those 
persons, taken at random in the general population whose 



190 MENTAL HEALTH OF SCHOOL CHILD 

schooling and training are about of the same character, 
cannot now be said. 

One of the most striking peculiarities of the epileptic 
curve is its decidedly skewed or anomalous character, 
noticeable particularly between ages eight and eleven. 
The curve presents a marked contrast with the curve of 
feeble-mindedness in this respect. The latter is character- 
ized by a fairly uniform rise up to and including age seven, 
and by a rapid and uniform fall after age eight. It has 
more or less of the normal bell-shaped appearance. But 
in the epileptic curve there are two irregular drops in the 
ascending portion, a minor at five and a major at nine. 
The former does not possess much significance, because of 
the small number of subjects tested in the lower ages. It 
may be regarded merely as a fortuitous phenomenon. But 
in a typical curve of frequency the rise from age six 
should have been continued without any marked break at 
nine to the apex at ten. It is, therefore, apparent that the 
accidental factors which normally operate to produce an 
unskewed or bell-shaped curve of frequency, were inter- 
fered with in our testing by some constant factor or 
factors. These factors can only reside in the method of 
giving the tests, or in the nature or arrangement of the 
tests themselves, or in the peculiar mental organization 
of the epileptics resulting from their inborn constitution 
or from processes of degeneration.*' 

There must either be certain defects in the mentality of 
epileptics, that is, at the nine-year level, for we find 24.9 
per cent of epileptics grading ten years old as against 

6 Another factor may have to be considered, the relative propor- 
tion of children among the epileptics and feeble-minded. One-third 
of the epileptics were under twenty-one years of age; the correspond- 
ing figure for the feeble-minded is 54 per cent. 



PSYCHO-CLINICAL RESEARCH 191 

only 8.4 per cent grading nine years old ; or we must con- 
sider the ten-year-old tests as normally too easy and the 
nine-year tests as too difficult ; or otherwise some factor 
extraneous to the tests themselves has been operative. 

The method of testing possibly plays a minor role, for 
while the method used has followed that in vogue at Vine- 
land, there is this possible difference : my testing has been 
done with great thoroughness in this respect, that instead 
of confining the testing of the patients to the ages imme- 
diately beneath or above the ages in which they grade, I 
have tested the majority throughout the greater part of 
the scale. This was done, not merely to arrive at a more 
complete clinical picture — to reveal the peculiar mental 
lapses, gaps and remnants which may be assumed to ac- 
company degeneration changes- — but in order to test the 
reliability of the scale itself. For tliis purpose nothing but 
a thoroughgoing try-out will suffice. '^ 

This thorough testing has given some interesting results, 
which we cannot enter upon here further than to say that 
scores of low or medium grade epileptics were found who 
passed one or more tests in a half dozen higher age levels, 
and who received from ten to twenty (in a few cases from 
twenty-five to thirty) advance points from the first age 
actually passed. Certain mental remnants from higher 
psychic levels remained to tell the story of the wreckage 
wrought by the disease. At the same time, scores who 
passed the higher age tests failed in individual tests at 
lower levels. Two years particularly proved veritable 
pontes asinorum, namely ages six and nine. No per cent of 
those who are classified in age six passed the tests of this 
age (that is, all the tests or all but one), while only 10 per 

T Such a try-out must be made, of course, primarily on large 
masses of normal children. 



192 MENTAL HEALTH OF SCHOOL CHILD 

cent of the Binet-Simon nine-year-olds passed the tests of 
this year. Only 29 per cent of the groups of patients who 
grade six, seven, eight, nine and ten years old passed the 
six-year-old tests, while only 40 per cent of the nine, ten, 
eleven, twelve and thirteen year olds passed the nine-year 
tests. But what is of special interest to the question at 
issue now is the fact that the method of extensive testing 
used made it possible for patients to attain a different or 
higher classification on the basis of advance credits from 
numerous higher ages. That is why there is no fall in the 
curve at six, e.g., although not a single one of the six-year- 
olds actually passed all of the tests but one of that age. 
While tliis factor is thus of some importance, it does not 
explain why there is such a large number of ten-year-old 
patients, because the greater number of these (94 per 
cent) passed the ten-year-old tests while 84 per cent of 
them failed on the nine-year tests. There is some evidence 
to confirm the belief that the nine-year tests are too diffi- 
cult: the first obvious break in the curve of feeble-minded- 
ness comes at this age, while Katherine Johnstone,^ testing 
a considerable group of normal girls in the Sheffield, Eng- 
land, schools, found this year to be the most difficult. 
After making due allowance for these two factors — the 
thoroughness of the testing, and the intrinsic difficulty of 
the tests themselves — the facts would seem to force us to 
include a third factor. A detailed analysis of the records, 
and particularly of the failures at various levels, shows 
that the inabiUty to pass ages six and nine (eleven may 
also be included) is due, at least partly, to certain inherent 
defects in the epileptic mind. These defects, so far as 

8 Katherine L. Johnstone. Journal of Experimental Pedagogy, 
l:34f. (She also finds that some normal children pass higher levels 
while failing at inferior levels.) 



PSYCHO-CLINICAL RESEARCH 193 

pertains to these ages, arise : first, from a fundamental 
deficiency in memory span, as shown by the inability to 
repeat a sentence of sixteen syllables heard once, to recall 
six units or facts from reading a short passage once, and 
to correctly state their ages in years ; second, from an 
inability to define common objects in terms of description 
or classification, or to define simple abstract qualities in 
terms of the essential idea ; third, from a blunting of the 
muscular sensibility, or a raising of the threshold of mus- 
cular sensory discrimination of weight ; fourth, from a fail- 
ure to grasp the essentials of a simple situation, as 
e\adenced by the inability to execute a simple triple com- 
mand, or to arrange shuffled words into an intelligible 
sentence ; and fifth, from a marked obstruction or retarda- 
tion of the stream of thought, as evidenced by the inability 
to utter sixty words in three minutes. 

From the very fragmentary account which we have thus 
given of certain aspects of our Binet work, we are able to 
frame a picture of an interesting spectacle : a case of 
mental wreckage, whereby the integrity of various mental 
functions has been impaired in various levels of mental 
development, and whereby various lower psychic levels have 
been swept away while higher levels remain intact. The 
mentality of epileptics makes up a constellation that is 
extremely irregular. To what extent the minds of the 
epileptic males differ from the females, and the children 
from the adults, as determined by the Binet scale, time does 
not permit us to discuss. Nor can we detail the interesting 
results obtained by plotting age curves (for the thirteen 
Binet ages) for various individual tests by which it appears 
that, although the scale surely does not accurately meas- 
ure every individual, it is, in the hands of the expert, a 
surprisingly serviceable means of classifying homogeneous 



194 MENTAL HEALTH OF SCHOOL CHILD 

masses or groups of individuals. These can all be graded 
relatively by means of a uniform measuring rod. To this 
statement we must except the highest grade epileptics, 
however. The capacities of a considerable number of 
these lie outside of the range of the scale. Altogether, the 
Binet-Simon scale offers an ingenious but simple, practic- 
able, objective and rapid device for estimating and classi- 
fying defectives. No other available scheme gives such a 
satisfactory preliminary survey. It can tell us in one hour 
facts regarding new admissions which would otherwise 
come only after weeks of observation and experience. To 
an audience of this kind, the great need of a practical and 
simple means of grading and classifying institutional cases, 
and the conspicuous present lack of a generally accepted 
or satisfactory method need not be emphasized. It is 
pertinent to lay stress on the fact that the Binet method 
marks a decided advance step, in spite of all its imperfec- 
tions. Supplemented by corresponding scales of personal, 
social and industrial efficiencies, this scheme of graded 
intelligence-tests offers considerable aid in the solution of 
a vexing problem. 



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CHAPTER VIII 

THE PRESENT STATUS OF THE BINET-SIMON 
GRADED TESTS OF INTELLIGENCE^ 

The Binet-Simon graded tests of intellectual develop- 
ment, or similar ampKfied and standardized tests, give 
promise of making so large a contribution to the methodo- 
logical technique indispensable in the scientific study of all 
sorts of mentally deviating and defective individuals, that 
too much time cannot be devoted to the critical examina- 
tion of the tests, in order to determine the accuracy and 
relevancy of the scale. It is no less necessary in psycho- 
logical than in medical or biological investigations to 
rigorously adhere to the accepted rule in the physical 
sciences, that before making any measurements whatever 
it is necessary to determine whether the instruments of 
research are accurate, and if not what the amount of the 
inaccuracy is. 

There are at least four methods available by means of 
which we may test the accuracy of measuring scales of 
intellectual capacity. 

The first method is to test masses of supposedly normal 
children, and determine the percentage of passing for 
each test in each age-norm or for each collective age-norm. 
At the present time we have the returns from a number of 

1 Read before the American Psychological Association, at the Wash- 
ington meeting, December 27, 1911. Reprinted from The Alienist and 
Neurologist, May, 1913. 



BINET-SIMON GRADED TESTS 197 

scattered surveys made by the Binet-Simon method in 
France (Binet and Simon), Belgium (Decroly and De- 
gand), England (Katherine Johnstone), America (God- 
dard) and Germany (Bobertag). These studies represent 
much painstaking work, and are valuable contributions. 
But they are more or less unsatisfactory for various rea- 
sons. The number of children tested in each age, at least 
in some ages, has been rather limited. In the absence of 
any definite criterion by which to select a normal or typical 
or average cliild, the children tested have been largely 
selected at random. And the testing has usually been of 
the narrow-range type. By a narrow-range type of 
testing I refer to surveys which are limited to the child's 
chronological age and one or two higher and lower ages. 
Such limited surveys made on a small number of children 
are practically worthless for the purpose of arriving 
at an adequate clinical picture of the child's mental condi- 
tion, or for determining his mental status, or for the pur- 
pose of trying out the accuracy of the scale, because from 
all that we know about human nature from a number of 
psychological and pedagogical investigations, mental 
traits, whether original or acquired, differ very consider- 
ably in children of the same chronological ages or of the 
same school classification. The defectiveness of restricted 
testing has been forcibly brought home to me from my own 
wide-range testing of a colony of epileptics, and from a 
less extensive testing of certain types of insane patients. 
From the wide-range method of testing epileptics with the 
Binet-Simon scale it appeared that dozens of those who 
were only able to pass one of the lower age-standards 
passed one or more tests in a half dozen higher ages, and 
several of those who failed on the age standards between 
six and nine passed age ten. It is necessary to remember 



198 MENTAL HEALTH OF SCHOOL CHILD 

in the later discussion that the surveys thus far made on 
public school children have usually, perhaps nearly always, 
followed the narrow-range method of testing (the writers 
have given little information to the public on this impor- 
tant point). 

It is important to raise the question as to whether a 
try-out of the tests to prove thoroughly satisfactory must 
not be based on fairly normal or typical children, and not 
on mixed groups of normal, subnormal and supernormal 
children. Even among normal children, so-called, we shall 
always find a considerable amount of variation in the 
strength of any trait or capacity ; but if we include both 
dull and bright children the variation becomes so large 
that the survey can scarcely be used for the purpose of 
testing the reliability of the scale. It may be frankly con- 
ceded that we have no fixed standard of what constitutes 
the normal child in any age, but we are in a position to 
use a fairly satisfactory criterion by which to select 
average children, namely, the degree of pedagogical 
arrest or progress which the child has shown in his school 
work and the number of physical defects found by careful 
medical inspection. 

A second method by which to test the accuracy of scales 
of mental development is to test the same groups of 
normal children annually. If the scale is measurably 
correct the children should gain approximately one mental 
age with the passing of each calendar year. No detailed 
studies of this sort, on normal children, made by the 
Binet-Simon scale, have yet been published, so far as 
I am aware. 

A third method is to classify by mental ages all the 
members of homogeneous groups of individuals, such as 
entire colonies of epileptics or entire institutions for the 



BINET-SIMON GRADED TESTS 199 

feeble-minded or the insane. The curves of distribution 
or surfaces of frequency from such surveys should, from 
the theory governing distributions controlled by chance 
factors, assume the normal, bell-shaped appearance. In a 
homogeneous group (at least of persons who have reached 
maturity) the mental stations of the individuals should 
cluster around one mode. From this mode approximately 
equal negative and positive departures would occur. The 
frequency of the departures would depend upon their size ; 
the larger the departure, the smaller the frequency. The 
curve, accordingly, will taper off in the form of a bell ; and 
if any marked skews occur it is evident that the group in 
question is not a typical group — the group is, so to say, 
a loaded group because, certain factors having received 
undue emphasis in its selection, the law applying to chance 
distributions does not hold — or the size of the group is too 
small to furnish reliable data, or there are inequalities or 
irregularities in the measuring scale or in the method of 
testing, or the group is so peculiar or anomalous as not 
to be in accordance with Gauss' curve. Two Binet-Simon 
curves of distribution have been constructed for homo- 
geneous groups of individuals, and are available for tliis 
study. 

A fourth method of evaluation is to plot efficiency or 
capacity curves for each separate trait in all the mental 
ages in which the given trait has been tested. If the 
individuals of a given group, whether normal or abnormal, 
have been classified with approximate accuracy by the 
scale, then we should expect a gradual rise in the efficiency 
or capacity curve with each higher mental age, or at least 
with every second or third higher age. Thus the children 
classifying as of six years of age ought to be able to 
repeat more detached words in three minutes than the 



200 MENTAL HEALTH OF SCHOOL CHILD 

children grading five, and the seven-year-olds more than 
the six-year-olds, etc. Moreover, instead of testing the 
relevancy of the scale by plotting efficiency age curves 
merely for the traits which are tested in the scale itself, 
we may employ extraneous tests. Thus if the children have 
been properly classified by the scale we should expect those 
who grade eight mentally to replace the blocks in a form- 
board more rapidly than those who grade six or seven, 
and so on. This would not hold true, of course, for every 
individual, but it should hold for masses of individuals. 
The gradual increase of efficiency or capacity may be 
expected to continue up to the point where the trait in 
question reaches its maturity or maximal development. 
This will be followed by a period of stationary efficiency 
which will continue to the beginning of the period of 
decline or of involution changes. 

In the case of curves which are based on abnormal per- 
sons, such as epileptics, the feeble-minded and the insane, 
the validity of this method of testing the accuracy of the 
scales may be questioned. But it seems reasonable to sup- 
pose, and the supposition is in accordance with such evi- 
dence as we have, that if, say, fifty epileptics grade eight 
mentally, fifty grade nine and fifty grade ten, the average 
efficiency of a given trait will be less for the eight- than 
the nine-year group, and less for the nine- than the ten- 
year group. Hence the legitimacy of the method can 
scarcely be questioned so far as concerns the testing of 
the reliability of the scale for classifying the individuals 
of a given homogeneous group. Moreover, if we grant the 
contention that the individuals of the human race (the 
idiots possibly excepted) are not classifiable into disparate 
groups or classes, separated by distinct gaps, but that 
they diff^er merely in degree — quantitatively, not qualita- 



BINET-SIMON GRADED TESTS 201 

tively — so that all can be ranged on a common surface of 
frequency in respect to any trait or combination of traits 
which may be tested, then we may assume that the strength 
of different mental traits in a group of abnormal indi- 
viduals who classify, say, as nine mentally, should be 
approximately the same as in a group of normal persons 
who classify as nine. This would not hold for every pos- 
sible trait, but probably would hold for the average of the 
various traits tested in the same age. It has been neces- 
sary thus to advert to these premises because no graded or 
age growth curves for individual traits have thus far been 
plotted with a view to testing the relevancy of the scale, 
save those to which reference will be made in this paper. 

What, now, do the results of the surveys made by vari- 
ous workers indicate with respect to the correctness of the 
Binet-Simon scale .f* The space at our disposal makes it 
necessary to limit the discussion to a very brief recapitula- 
tion of a more extended monographic treatment.^ We 
shall take up first of all the curves of distribution. 

In my plotting of a curve of distribution (Graph IV, 
p. 187) for a homogeneous group of mentally impaired 
persons (epileptics), two obvious skews attract the eye, 
a minor one at five and a major one at nine. The drop in 
the frequency at five is negligible, for reasons that cannot 
be entered into here, but the drop at nine clearly appeared 
to be abnormal. Only 8.4 per cent of the epileptics graded 
nine years while 24.9 per cent graded ten years mentally. 
A minute analysis of the data indicated that the irregu- 
larity at nine could be traced to four causal factors : the 
wide-range method of testing, the method of scoring, 

2 Experimental Studies of Mental Defectives: A Critique of the 
Binet-Simon Tests, and a Contribution to the Psychology of Epilepsy, 
Warwick and York, Inc., 1912. 



202 MENTAL HEALTH OF SCHOOL CHILD 

inherent inequalities or anomalies in the mental make-up 
of epileptics, and inherent inequalities or defects in the 
Binet-Simon scale itself. Of these factors the last two 
were far and away the most important. 

The above skews in the curve furnished presumptive 
evidence that the scale was not maximally correct. This 
presumption was abundantly confirmed by a further analy- 
sis of the data, which showed that several age-standards 
were entirely too difScult, more particularly ages six and 
nine. It was discovered, for example, that none of those 
who are classified as of age six were able to qualify on this 
age-norm (i.e., pass all the tests but one) : they all made 
the six-year standard on the basis of advance credits. 
Only 29 per cent of those who grade six, seven, eight, nine 
and ten passed the six-year standard. Similarly only 
10 per cent of the Binet-Simon nine-year-olds, and only 40 
per cent of all those grading from nine to thirteen, passed 
the nine-year standard. These results for epileptics, taken 
by themselves, would be suggestive although possibly not 
convincing. But, unfortunately, similar inequalities in the 
age-standards appear in the pubHshed data based on the 
testing of public school children. In Katherine Johnstone's 
testing of public school girls in England (Sheffield), 
twenty-four out of thirty nine-year-olds failed on the nine- 
year norms ; and in Goddard's testing of school children in 
our own country, the number of six-year-olds who were 
able to satisfy the seven-year norms was larger than the 
number who passed age six, a larger number of eight-year- 
olds stayed in age seven than made age eight, more nine- 
year-olds were able to pass the ten- than the nine-year 
norm, an unusually large number of ten-year-olds qualified 
on the standard for this age while a much smaller per- 
centage of eleven-year-olds could pass the standard of that 



BINET-SIMON GRADED TESTS 203 

age, and more twelve-year-olds classified as ten than as 
twelve. 

These relative disproportions in the collective difficulty 
of the different age-norms are, of course, ultimately de- 
pendent on inequalities or misplacements of the individual 
tests which make up a given age-norm. When the results 
are critically examined it is found, as a matter of fact, that 
there is an amazing lack of uniformity between the differ- 
ent tests of the same age. The extent of this inequahty 
may be expressed in quantitative terms by the average 
mean variations between the percentages of successes for 
all the tests of the same ages. No mean variations have 
been computed except for a colony of epileptics. For the 
epileptics the M. V.'s amount to over .20 in four ages 
(I-II, III, VII, IX), and less than .14 in six ages (V, VI, 
VIII, X, XI, XII), while the average for the thirteen ages 
amounts to .17. 

Similarly the differences between the easiest and most 
difficult tests in the same ages, based on the performances 
of the epileptics who classify in the given ages, amount to 
as much as 62 per cent in age six, 57 per cent in age twelve 
and 56 per cent in age nine ; while, correspondingly, the 
smallest ranges are 11, 21 and 24 per cent for ages four, 
eight and one, respectively. It is thus evident that most 
of the age-norms contain tests varying conspicuously in 
difficulty. Some are too difficult, some too easy and others 
about right. 
I /■ Here, again, the findings among epileptics are par- 
alleled in the results of the public school testing. Limita- 
tions of space render it quite impossible to indicate the 
status of all the tests in the scale. I shall, therefore, only 
take space to mention some of the tests which most ob- 
viously appeared in my own testing to be misplaced, and 



204 MENTAL HEALTH OF SCHOOL CHILD 

which Hkewise proved to be improperly located when 
judged by the testing of ordinary runs of public school 
children. 
I Among the tests which have proved to be too difficult 
for the age to which they have been assigned are the 
following : 

Age V, rearranging triangles. Age VI, repeating six- 
teen syllables. Age VIII, copying a dictated phrase. Age 
IX, giving correct change, classificatory or descriptive 
definition, six memories and arranging five or six weights. 
Age XII, repeating twenty-six syllables. Age XIII, all 
tests. 

The following tests, on the other hand, have proved to 
be too easy for the age to which they have been assigned. 
Age VII, counting thirteen pennies. Age VIII, naming 
four colors. Age X, naming money. Age XII, three 
rhymes.^ 

In the case of a number of tests (including some of the 
above) the results of different investigators are discrepant. 
The discrepancies are probably due, in part, to the fact 
that uniform testing conditions have not always been 
followed by different workers, and to the fact that there 
are national differences in the strength of various mental 
traits. Tests which are too difficult for children of one 
nationality may not be too difficult for those of another, 
but just right, or quite the reverse. 

In considering some tests as too difficult and others as 
too easy, it is obvious that we have posited a norm or 
standard of normal variation for each age-norm. We have 

3 For figures which will substantiate the above conclusions consult 
the writer's Experimental Studies of Mental Defectives: A Critique 
of the Binet-Simon Tests, and a Contribution to the Psychology of 
Epilepsy, Warwick and York, Inc., 1912. 



BINET-SIMON GRADED TESTS 205 

proceeded on the assumption that age-norms do not pos- 
sess any scientific value unless a certain minimum percent- 
age of so-called nonnal children pass the norms for their 
chronological age. It is evident that if, say, only 25 or 
30 per cent of typical or average children pass the indi- 
vidual tests or the collective norms for their age that the 
norms are worthless. It is equally evident that the require- 
ments are too exacting if the standard of passing were 
fixed at 100 per cent, since, as already stated, mental 
traits, even in normal children, will vary considerably from 
the mode or central tendency. A certain amount of varia- 
tion in the capacity of average children of the same age 
must be regarded as perfectly normal. Mental measure- 
ments, at their very best, are variables and not fixed con- 
stants. Therefore the question, in the final analysis, 
reduces to this : What shall we regard as the maximal per- 
missible amount of variation in the difficulty of age-norms 
in a measuring scale of intelligence which lays claim to the 
character of a scientific measure.^ The extreme limit may 
be fixed, I believe, at 25 per cent. That is, if 75 per cent 
of fairly normal children fail to pass the norms set for 
their age, the latter may be regarded as too difficult. 
Certainly, one of the problems for future investigation is 
the determination of the normal or maximal aTHoitnt of 
variation allowable in normal age-norms — the establish- 
ment of normal norms of variation. 

Now, if we accept the 25 per cent criterion of variation 
as the limiting point, it is evident that the Binet-Simon 
scale is far from perfect, even altogether aside from the 
question as to whether the tests themselves are legitimate 
tests of intelligence or of intellectual development. The 
mere inequalities in the scale are, in fact, such as to sug- 
gest that it can be of little if any utility. But this con- 



206 MENTAL HEALTH OF SCHOOL CHILD 

elusion cannot be justified, I believe. Even with all its 
imperfections the scale is a fairly serviceable objective 
instrument for determining the relative mental station of, 
or for classifying, homogeneous groups of defective indi- 
viduals. This I have attempted to demonstrate by plotting 
efficiency curves for each of the following individual traits 
in epileptics : the time required to name four colors, to 
replace the blocks in a form board, and to read a given 
selection ; the number of units or memories reproduced from 
the reading selection, the number of detached words men- 
tioned in three minutes, the strength of the left and right 
hand grip, and the ataxiagraphic sway of the body.* As 
already stated, if the patients were correctly graded by the 
scale there should be an increase in the strength of each 
mental trait with each successive Binet age. As a matter 
of fact, most of the curves thus constructed show an 
improvement from age to age. This improvement is fairly 
smooth or regular except in the color, dynamometry and 
ataxiagraphic tests. Such inequalities as appear in the 
other graphs are probably often due to the small number 
of subjects tested in certain ages. The strongest indict- 
ment of the scale furnished by these curves is supplied by 
the mean variations. These vary from 15 to 57 per cent 
for each age, with an average of nearly 30 per cent. While 
a variation of 10 or 15 per cent is regarded as quite con- 
siderable in various psychological measurements, we need 
to determine by experimental means, as has been said, 
what should constitute a normal or maximal amount of 
variation in normal age-norms. In any case, the maximal 

4 See my Experimental Studies of Mental Defectives : A Critique 
of the Binet-Simon Tests and a Contribution to the Psychology of 
Epilepsy, Baltimore, 1912, 112f. 



BINET-SIMON GRADED TESTS 207 

permissible variation would, as suggested, probably not 
exceed 25 per cent. 

We may conclude, then, that this objective measuring 
scale, however imperfect, enables us to grade and classify 
defectives more accurately than can be done by unaided 
observation. The serviceability of the scale may be illus- 
trated from one of my recent examinees, a male katatonic 
dementia precox case, age forty-two, a graduate of an 
agricultural college, now an inmate of one of the Iowa 
hospitals for the insane. According to the clinical and 
ward records made annually by the physician in charge, 
the patient had been gradually dementing for seven or 
eight years and at the time of my visit was thought to have 
reached a very low mental level. Certain observations 
made by the superintendent of the institution, however, had 
raised the presumption that this patient was in a better 
state of mental preservation than the records indicated. 
He was accordingly put through the Binet-Simon scale. 
The result was a surprise. All of the thirty highest tests 
in the scale were successfully passed with the exception of 
two, one owing to disorientation in time and one owing to 
a slight impairment of the weight sense. Not only so, the 
responses were nearly always prompt, decisive and well 
expressed. Twelve units were reproduced from the reading 
selection, which he read in twenty-seven seconds, the prob- 
lem questions were answered in from three to thirty 
seconds, the words in the three shuffled sentences were cor- 
rectly arranged in six, seven and thirty seconds, respec- 
tively, and the seven numbers and twenty-six syllables in 
age twelve were reproduced instanter. A wrong act com- 
mitted in anger should be forgiven more quickly than one 
not committed in anger because 'anger is a disease.' 
'Evolution in mathematics occurs in connection with square 



208 MENTAL HEALTH OF SCHOOL CHILD 

and cube root and permutation, while revolution in society 
is disorder leading to war.' 'Poverty is a state of being 
without riches, while misery is the absence of correct 
feeling.' 'Pride is a state of mind in which we show elation 
over our possessions or certain attributes of ourselves, 
while pretension is deceit or false claim.' 

Here is a patient who had suffered from mental disease 
for about a dozen years. One hour of Binet-Simon testing 
was sufficient to show that he was practically normal 
intellectually (his obsessions excepted). And yet this fact 
had not only not been revealed by years of unaided obser- 
vation by competent observers, but unaided observation 
had. been completely misled. The scale, even as at present 
constituted, has undoubted value as a gauge for locating 
mental status. 

Nevertheless, it is essential that we recognize the limita- 
tions and present imperfections of the 1908 scale. The 
scale is not, as some recent magazine and newspaper 
exploiters would have us beheve, a wonderful mental 
X-ray machine which will enable anyone to dissect the 
mental and moral mechanisms of any normal or abnormal 
individual, a talisman which will transform any ordinary 
observer into a psychic wizard and enable him to infallibly 
measure mental status. Moreover, it has not yet been 
adequately shown that the later revisions are not also in 
need of extensive rectification and amplification (see 
Chapter X). 



CHAPTER IX 

CURRENT MISCONCEPTIONS IN REGARD TO 
THE FUNCTIONS OF BINET TESTING 
AND OF AMATEUR PSYCHO- 
LOGICAL TESTERS^ 

Brevity is said to be the soul of wit, but it often subjects 
one to the charge of dogmatism. Because of the time 
restrictions imposed upon this paper, I fear that I shaU 
appear somewhat dogmatic in the theses wliich I shall lay 
down in a more or less categorical fashion. But the con- 
clusions arrived at have been formed as a result of the 
psycho-clinical study of a considerable variety of normal 
and abnormal mental types. 

1. The first popular misconception to which I invite 
your attention is the idea that mere formal, stereotyped 
psychological testing by any system of tests whatsoever is 
all there is to a psychological examination. The fact is 
that formal testing is only on^ of the many phases of a 
mental examination. To be sure, it is a fundamentally 
important phase. The development of an objective con- 
trolled psychological testing technique has brought order 
out of chaos in the field of psycho-educational diagnosis, 
and has done more than anything else to render the work 
of psychological examination respectable and scientific. 

1 Delivered at the conference on the Binet-Simon scale, Fourth 
International Congress on School Hygiene, Buffalo, N. Y., August 
29, 1913. Printed here in greatly abbreviated form. 



210 MENTAL HEALTH OF SCHOOL CHILD 

But, while this is so, it must not be forgotten that there are 
many important clinical and developmental aspects of 
mental deviations which cannot adequately be revealed by 
mechanical testing, whether by the Binet or any other 
system of tests. ^ These conclusions have been sufficiently 
emphasized in Chapter IV. 

2. Because psychological diagnosis involves more than 
the ability to administer a set of formal mental tests, it 
is preposterous to suppose that one may become a com- 
petent psycho-educational examiner by taking a short 
university course on mental tests or by taking a six-weeks' 
summer course in a training school for teachers of mental 
deficients. There is no 'royal road' either to psychological 
or physical diagnosis. There is no educational magic by 
which we can, in a five or ten weeks' course, transform an 
ordinary observer into a psychic wizard and confer upon 
him extraordinary powers by which he will be able to 
divine or dissect the mental make-up of children. 

Let me say here that the evils which have been creeping 
insidiously into clinical work in education and psychology 
may be partly attributed to the recent practice of psy- 
chologists, most of whom are in no sense clinical men, of 
off"ering courses on 'mental and physical tests' to 'all 
comers,' with the implication that anyone who takes the 
courses will be qualified to diagnose children in the schools. 
Unfortunately, those who take such courses usually make 

2 The following confirmatory opinion is apropos: 'I do not think 
that we can label a child as defective in mind by any fixed test, or 
set of tests, no matter how carefully thought out. As a means of 
exploring the workings of a child's mind they are undoubtedly 
useful, but they cannot properly be regarded as standards. Judged 
by them alone, the minds of many children who are not mentally 
defective will be weighed in the balance and found wanting.' — Fred- 
erick Langmead, M.D., School Hygiene, London, 1913, p. 18. 



CURRENT MISCONCEPTIONS 211 

this implication, and believe that somehow miraculously 
they have become competent examiners, even though the 
instructor has taken pains to emphasize the fact that no 
one can become a reliable educational diagnostician with- 
out spending several years in the technical didactic study 
of psychology and education, and in the first-hand clinical 
study of different mental types. I have deliberately 
limited eligibility to my psycho-clinical practicum to three 
classes of students ; first, to those who desire to fit them- 
selves to become expert psycho-educational examiners and 
who are willing to spend sufficient time to make themselves 
thoroughly competent ; second, to those who seek to develop 
skill in the technique of administering certain mental tests, 
in order to qualify as trained assistants to the expert 
diagnostician ; and third, to those who, seeking a practical 
course in child psychology, desire to observe and study 
children in the concrete by means of tests, for the sake of 
gaining insight into children's minds from a new view- 
point, and not for the sake of quahfying themselves as 
psycho-clinical examiners. I would no more regard the 
two latter classes of students as competent clinicists than 
I would regard students who had taken an introductory 
experimental course in psychology as competent univer- 
sity professors of psychology. My demonstration clinics 
are, of course, open to all who take the didactic courses. 

Departments of psychology and education in universities 
must be held accountable for maintaining higher standards 
of clinical work in psychology and education. They must 
raise their standards just as the medical schools have 
latterly been forced to adopt higher standards of work. 
Potential 'quacks' should be kept out of the field of 
psycho-educational diagnosis no less than they should be 
kept out of the field of medicine. 



212 MENTAL HEALTH OF SCHOOL CHILD 

To be sure, psycho-educational amateurs, whether teach- 
ers, nurses or physicians without extensive psychological 
or educational training, may be competent to administer 
formal psychological tests, provided they have been suffi- 
ciently trained. My experience indicates that it requires 
two exercises per week during a ten weeks' summer course 
so to train teachers,^ principals, social workers and college 
graduates that they will be able to administer merely the 
Binet tests with accuracy and facility and with confidence 
in themselves. But although it is possible to prepare 
measurably competent testers in short courses on mental 
tests and on the psychology and pedagogy of mentally 
exceptional children, we must not, therefore, deceive our- 
selves with the thought that we are thereby training 
competent psycho-educational diagnosticians. A person 
trained in short psychological and educational courses can 
no more be considered a skilled psychological and educa- 
tional clinicist than a nurse who has had even three full 
years of training can be considered a skilled physician or 
surgeon. The skilled psycho-clinicist would no more think 
of intrusting his diagnoses to the 'mental tester' than the 
skilled physician or surgeon would intrust his diagnoses to 
the nurse. The role of the Binet tester and the nurse is 
precisely similar : their function is that of the assistant to 
the trained specialist. The medical nurse may serve as a 

3 A recent critic avers that teachers can be trained to become 
perfect Binet testers during a five weeks' term by listening to lectures 
and discussions on the tests, by observing ten testings (six of these 
by beginners) and by testing three pupils. Granted. But these 
claims can scarcely be proved by having beginners test feeble-minded 
children who have been tested again and again by the Binet tests, 
and who can, therefore, answer the questions in essentially the same 
way even though they may be improperly asked. However, the essen- 
tial point is: Binet testing is one thing, diagnosis is another. 



CURRENT MISCONCEPTIONS 213 

trained examining assistant, taking the pulse, tempera- 
ture and respiration, assisting in the examinations and 
administering treatment. Likewise, the mental tester may- 
serve as a trained examining assistant, gathering various 
data, administering certain tests, and supervising treat- 
ment ; but neither the nurse nor the Binet nor any other 
psychological tester is a skilled diagnostician. The mental 
diagnostician must be able not merely to locate the mental 
level, but also to form a comprehensive psycho-clinical 
picture of his case. In order to prognose with measurable 
accuracy, he must be able to trace symptoms to causes, 
and correctly differentiate types. Mere psychological 
testing does not indicate whether we are dealing with cases 
of infantilism or simple imbecihty, of cretinism or mon- 
golism, of moronity or backwardness, of aprosexia or 
dullness, of inherent or merely apparent mental deviation, 
of stupor or amentia, of permanent or recoverable impair- 
ment, of progressive chorea or paralysis, of psychotics or 
neurotics, of epilepsy or hysteria, of idioglossia or baby 
talk or partial aphasia, of stuttering or partial aphasia 
or tic speech. But a diagnosis involves the making of 
precisely such differentiations. 

From what I have said it is evident that psycho-clinical 
diagnosis and prognosis must be based on the entire 
symptomatology of the cases and not merely on a few me- 
chanical tests. Hence, let us disillusionize ourselves of the 
smug belief that psychological and educational diagnoses 
are easy or trivial matters. In many cases they are con- 
siderably more complicated and baffling than physical diag- 
noses ; and in any case a skilled psycho-educational 
diagnostician will require a preparatory course of training 
not one whit less technical or elaborate than the course 
required by the skilled ocuhst, neurologist or psychia- 



214 MENTAL HEALTH OF SCHOOL CHILD 

trist. If the science and art of psycho-educational diag- 
nosis could be mastered in a summer course, or a couple of 
short university courses, it would be safe to set it down as 
humbug. Several teachers of more than average training, 
who have taken my courses and who have elsewhere 
observed or tested feeble-minded or backward cases during 
a six weeks' summer term, have remarked that they have 
been unable satisfactorily to diagnose all cases which they 
have studied even under these very favorable conditions, 
and that they regard it as entirely improbable that 
teachers, nurses or physicians who have been trained to 
give a few formal psychological or educational tests have 
thereby acquired such a profound understanding of the 
children's mentahty that they are qualified to educationally 
classify them correctly and to direct their educational 
development. 

The above reasons, among others, have lead me to affirm 
frequently that the department of psycho-educational 
diagnosis in the schools belongs in the educational division 
rather than in the department of medical inspection (see 
Chapter II). No medical inspector can make a satis- 
factory educational diagnosis and offer sane advice regard- 
ing the child's educational development unless he is a 
technically trained educationist. 

3. A third set of misconceptions relates to the accu- 
racy of the Binet-Simon scale. On the one hand, there 
are the exploiters or enthusiasts who claim that the tests 
are infallible, and certain serious and perfectly sincere 
students who, somewhat more modestly, claim that the 
tests are astonishingly accurate. On the other hand, 
there are able students who claim that the tests are utterly 
worthless or only of secondary consequence. During 
several years I have been making a study of the tests with 



CURRENT MISCONCEPTIONS 215 

a considerable variety of cases, and have gradually formed 
the conclusion that the tests, in spite of their imperfec- 
tions, are of considerable value to the trained examiner 
(see Chapter VIII). They provide a fairly impersonal 
and uniform method by which to grade or classify, with a 
fair degree of accuracy, institutional and school cases rela- 
tively to one another. Sometimes they enable us to locate 
the mental level of individual cases with surprising accu- 
racy. But it is absurd to say that the tests are 'astonish- 
ingly accurate.' The construction of the scale itself is by 
no means perfect (as has been shown in Chapter VIII). It 
is equally absurd to claim that the tests provide a means 
for making an 'infallible' diagnosis. On the contrary, as 
already shown in Chapter IV, they may lead to utterly 
worthless, fallacious, monstrous or pernicious diagnoses, 
and they cannot be regarded as strictly rehable, not to say 
infallible, shortcuts for differentiating the backward from 
the feeble-minded, or the normal from the supernormal, or 
the psychasthenic from the asthenic, or the Freudian 
psycho-neurotic with retardation from the mentally defi- 
cient. Valuable as they are, they are not a diagnostic/ 
automaton which will serve as a satisfactory substitute for • 
an expert examiner. 

4. And finally : the impression prevails that adequate 
and reliable clinical norms can be established by group 
tests or by the random testing of limited numbers of 
children. This misconception is discussed in Chapter X. 



CHAPTER X 

RE-AVERMENTS RESPECTING PSYCHO- 
CLINICAL NORMS AND SCALES OF 
DEVELOPMENT^ 

Recent discussions seem to call for a reemphasis of 
certain conclusions at which I had previously arrived. 

1. An expert experiment al, educational or genetic 
psychologist is not, in any legitimate use of the word, a 
skilled clinical psychologist.' The former has no more 
right to regard himself as an expert cHnical psychologist 
than the professional anatomist or physiologist has to 
consider himself a medico-clinical examiner. The skilled 
psycho-clinicist will require just as prolonged and 
thorough a technical preparation as the skilled medico- 
clinicist.^ Just as the preparation of the physician neces- 
sitates more than a thorough grounding in anatomy, phy- 
siology and embryology, so the preparation of the clinical 
psychologist requires more than an expert knowledge of 
general, experimental, educational, genetic or abnormal 
psychology or of child study.* He should have in addition 
a thorough training in psycho-clinical procedure, which 
should include not only work in a laboratory clinic but an 

1 Reprinted, with various additions, from The Psychological Clinic, 
1913, pp. 89-96. 

2 Science, 1913; Journal of Educational Psychology, 1912, p. 234. 

3 Journal of Educational Psychology, 1912, p. 224f; Science, 1913. 

4 Journal of Educational Psychology, 1911, p. 207f. 



PSYCHO-CLINICAL NORMS 217 

intemeship — a 'hospital year,' so to speak, — spent in first- 
hand study of backward, feeble-minded, epileptic, psycho- 
pathic and disciplinary cases. These cases must be 
juvenile subjects if the examiner intends to work with chil- 
dren. He must have also a thorough training in educa- 
tional therapeutics. By this I include primarily not the 
so-called psycho-therapeutics of the skilled psychiatrist or 
psychopathologist— suggestion, psycho-analysis, reeduca- 
tion — but particularly the differential, corrective peda- 
gogics of the educational expert on mentally deviating 
cliildren. There is, however, no general scheme of correc- 
tive pedagogics. The methods will have to be differentiated 
to meet the needs indicated by a diagnosis of each case. It 
will be as different for the feeble-minded and for the 
stutterer as it is for the deaf and for the blind. Finally, 
the clinical psychologist must have some knowledge, didac- 
tic and clinical, of physical, orthopedic and pediatric 
defects, of neurotic and psychotic symptomatology, and of 
personal, family and heredity case-taking. 

It is evident that there is no modern specialist who is 
equipped with all these elements of knowledge except the 
properly trained clinical psychologist. The general 
practitioner, pediatrician, orthopedist, neurologist, psy- 
chiatrist, educational, experimental, genetic or abnormal 
psychologist is lacking in some of the essentials which the 
expert psycho-clinicist must possess. The ordinary special- 
class teacher (or school nurse) is, of course, not to be con- 
sidered for a moment as a trained psycho-clinicist.^ To 

5 Experimental Studies of Mental Defectives, 1:110; Journal of 
Educational Psychology, 1912, p. 224. Medical Record, September 20, 
1913. A similar view is evidently entertained by Bruner, Addresses 
and Proceedings of the National Educational Association, 1912, p. 
lllOf 



218 MENTAL HEALTH OF SCHOOL CHILD 

be sure, well-trained classroom teachers can learn to 
administer a few tests, and may thereby be able to group 
some cliildren with approximate accuracy into retarded, 
normal and accelerated classes, just as an intelligent 
layman may be able to classify, with some accuracy, people 
into sickly and healthy groups. But surely the skilled 
physician attempts to do more than roughly classify his 
cases. In the measure in which he is competent, he makes 
a differential diagnosis of each case and adapts the treat- 
ment to the diagnosis. The problem of the competent 
psycho-clinicist is precisely the same : he must attempt not 
only to measure the amount of mental deviation but to give 
a differential diagnosis of each case. The teacher or nurse 
may, indeed, be of considerable service as an assistant to 
the psycho-clinicist — provided, of course, that she pos- 
sesses the requisite tact and the necessary technical train- 
ing. To her (or him) may be entrusted a considerable 
portion of the formal, mechanical testing, and the collec- 
tion of the data for the case histories. But her relation 
to the clinical psychologist is much the same as the relation 
which the trained nurse sustains to the skilled surgeon. 
The psycho-clinicist would no more think of entrusting 
the final diagnosis of a mentally abnormal child to the 
teacher or nurse, than the physician would permit a nurse 
to make a differential diagnosis of a physically diseased 
person. A teacher or nurse or physician, whose psycho- 
logical training is limited to elementary courses and to 
giving the Binet or other mental tests, has no more right 
to the title of clinical psychologist, than a nurse who is 
trained to take the temperature, pulse or any other medi- 
cal readings has a right to call herself a physician. 

It may always be necessary to utilize more or less 
unskilled, or only partially skilled, workers in the mental 



PSYCHO-CLINICAL NORMS 219 

testing of deviating children, because we shall probably 
not be able for a long time in the future to secure a suffi- 
cient number of adequately trained specialists to examine 
the millions of pedagogically deviating children which clog 
the wheels of our educational machine. But this crude 
type of work — routine testing by amateurs — will probably 
not enable us to select mentally retarded children with 
markedly greater precision than can now be done by the 
ordinary classroom standards for determining pedagogical 
retardation. Nor will it give us any markedly superior 
insight into the peculiarities of the mental defects of the 
children. Extensive use of the tests on various types of 
children (normal, backward, feeble-minded, epileptic, in- 
sane, precocious) has convinced me that many diagnoses 
by teachers, physicians or nurses based purely upon the 
Binet tests will be very misleading, often humorously 
absurd, and at times pernicious. The diagnoses which I 
make after an exhaustive study of all the available facts 
are quite at variance with the Binet rating in a consider- 
able percentage of cases. I am free to confess, however, 
that I have found the Binet scheme of more value than 
have the psychologists in the Chicago schools (judging 
by personal reports made to me by Dr. Bruner). 

It should be remembered that mental testing is only 
one phase of mental diagnosis ; the determination of mental 
status does not automatically include the determination of 
the causative factors. 'The function of the Binet-Simon, 
or any other graded scale of intelligence, is to give us a 
preliininary, and not a jinal survey or rating of the indi- 
vidual.' The testing is 'merely a point of departure for 
further diagnosis.'® Grade teachers or nurses are 'unfitted 

6 Experimental Studies of Mental Defectives, 109 



220 MENTAL HEALTH OF SCHOOL CHILD 

for the two highest functions of the psycho-clinicist. First, 
they are incapable of giving a satisfactory diagnosis (the 
chief consideration in any examination) of individual 
cases ; and secondly, they are unable to conduct research — 
to prosecute productive and constructive research.'^ And 
I want to repeat with all possible emphasis that the real 
function of the amateur — the examining teacher or nurse 
or the physician unskilled in psychology — in the schools is 
not that of the clinical psychologist or the expert diagnos- 
tician, but that of the laboratory assistant to the skilled 
diagnostician, who, so far as mental cases are concerned, 
must he the specially trained clinical psychologist. 

That there are only a few clinical psychologists who 
have an adequate conception of, and training for, this 
type of work it is almost needless to say — though unfor- 
tunately there are many teachers and psychologists who 
quite delude themselves (largely because of the prevalent 
fluid standards of what constitutes a skilled clinical exami- 
nation) into the belief that they are prepared to function 
as competent consulting psycho-clinicists. It is, however, 
no matter for wonder that there are only a few competent 
clinical psychologists — persons who are qualified to act 
as professional or trustworthy consultants rather than men 
who, themselves lacking in clinical experience, may be able 
to write learnedly on what the clinical psychologist should 
do. For clinical psychology is just in its infancy. But 
I believe it is safe to predict that the type of training 
insisted on in this book will in future be demanded of the 
mental examiner of deviating children. 

2. Norms of mental functioning established by experi- 
mental or educational psychologists by group tests on 

7 Journal of Educational Psychology, 1912, p. 235. 



PSYCHO-CLINICAL NORMS 221 

squads of children may have little practical value as 
clinical tests.^ There are various reasons why this is so. 

First — group tests require written responses. But the 
clinical psychologist must reduce written responses to a 
merely nominal amount, partly because children differ in 
the rate or skill of writing without evincing a correspond- 
ing difference in intelligence ; partly because many abnor- 
mal children suffer from special motor defects of the hand, 
so that they cannot do themselves justice in graphic tests; 
and partly because written responses require too much 
time. A comprehensive psycho-clinical examination is a 
time-consuming ordeal, hence there is no time to waste on 
the mechanics of writing. There are, of course, many 
valuable tests which can only be done in writing, and 
these should be given in as brief a form as may be feasible. 

Second — many of the best single group tests carried 
out by the experimental and educational psychologists 
cannot be given in less than from three to thirty minutes. 
It is quite practicable for the educational psychologist to 
give lengthy tests because usually during any one sitting 
he attempts to measure only a limited number of traits. 
But the psycho-chnicist, in order to get a comprehensive 
picture of his case, must test a very considerable number 
of functions. Hence the time of each test must necessarily 
be reduced to an 'irreducible minimum.' 

Third — experiments show that children do better when 
tested in groups than when tested singly.^ For this reason 
group norms may not be serviceable as clinical norms. 
Merely on a priori grounds, since the conditions of testing 
are different, we should always feel a certain amount of 
skepticism about the accuracy of clinical norms which have 

8 Alienist and Neurologist, May, 1912. 

9 See BuRNHAM, Science, 1912, p. 761f. 



222 MENTAL HEALTH OF SCHOOL CHILD 

been derived from group results. As a matter of fact, 
nearly all norms now in practical use, whether mental or 
anthropometric, have been secured by individual and not 
by group testing. 

It is just because our clinical norms must be based on 
individual and not on group testing that the task of 
securing them is herculean. It is this fact that I had in 
mind in previously emphasizing that the establishment of 
extensive and reliable clinical norms requires a large staff 
of workers and an ample subsidy.'^" The problem would 
be comparatively simple if group-norms could be used with 
assurance for clinical work: it takes no more time to test 
forty pupils at once in a group than to test one pupil 
alone. It is worth repeating, therefore, that it is probably 
not to the group results of the educational and experi- 
mental psychologists that we must look for our norms but 
to the clinical data of examiners of individual cases. At 
any rate, some one should make a comparative study to 
determine whether there is any difference between norms 
established by group tests and norms for the same tests 
established clinically. 

3. So far as concerns the probing of the efficienci/ of 
mental functions by testing, the Tnost serviceable clinical 
examining technique consists in the graded scales of intel- 
lectual, motor and socio-industrial {possibly also emo- 
tional) development.^^ The high value which Thomdike^^ 
ascribes to the correlation formula probably is justified so 
far as concerns the diagnosis of the school system or of a 

10 Journal of Educational Psychologj% 1911, p. 204; Alienist and 
Neurologist, May, 1912; Experimental Studies of Mental Defectives, 
1912, p. 56ff. 

11 Pedagogical Seminary, 1911, p. 74 ff. 

12 Science, 1913, p. 133. 



PSYCHO-CLINICAL NORMS 223 

number of individuals of the same ages when tested in 
groups. But the most valuable contribution made thus 
far to the technique of clinical diagnosis — and funda- 
mentally diagnosis means precisely clinical diagnosis — 
does not come from the correlation formula. If there is 
any professional psycho-clinicist whose constant reliance 
in the diagnosis of individual cases is the Pearson formula, 
I do not happen to know him. No one has yet selected 
tests for developmental scales on the basis of correlation 
coefficients, although it is probable that in the selection of 
tests for such scales preference should be given to tests 
which have been shown by group experiments to possess a 
high degree of correlation. Certainly the most important 
type of 'educational diagnosis' done today, from the point 
of view of the practical good accomplished for the children, 
is clinical diagnosis ; and the value of the technique of 
individual diagnosis would be little impaired if the corre- 
lation formula were non-existent. 

4. The position I have taken in favor of the continued 
use of the 1908 Binet scale until an extensive mass of 
clinical data is available for a thorougl ily scientific revi- 
sion of the sccde^^ seems to me to be justified by the develop- 
ments. The relocations of the tests do not always accord 
with the author's own findings, or with the findings of 
other investigators, and numerous contradictions and dis- 
crepancies have not been satisfactorily eliminated. The 
detailed analysis of the numerous revisions which have 
appeared in less than a year is here out of place. But it 
is well to remind the reader that Binet and Simon's own 

13 The Psychological Clinic, Vol. V, No. 7, December, 1911, p. 218; 
Journal of Educational Psychology, 1912, p. 224f; Alienist and 
Neurologist, May, 1912; Experimental Studies of Mental Defectives, 
1912, pp. 55, 117. 



224 MENTAL HEALTH OF SCHOOL CHILD 

1911 revision, so far as I can gather, is largely theoretical. 
Evidently it was made to meet some of the criticisms lodged 
against the 1908 scale: viz., inequality in the number of 
tests for each age ; the presence of scholastic or training 
tests ; incorrect placing of tests, etc. It was not based, as 
it should have been to meet any justifiable scientific de- 
mands, on the retesting of large masses of normal children. 
Moreover, some of the changes introduced into the scale 
fly directly in the face of experimental warrant. Thus 
the date test is placed in Age VIII although the authors 
maintain that naming dates are 'facts that boys of nine 
are just able to retain' (Town's translation). 'AH the 
children at eleven years' succeed in composing single sen- 
tences containing three designated words ; children of 
eleven succeed in giving sixty words in three minutes ; 'at 
eleven the majority' succeed in giving abstract definitions; 
and yet, notwithstanding these findings, these tests are 
placed in Age XII. Here we have the absurd procedure 
of placing tests in an age in which they do not belong, in 
the interests of a theoretical reconstruction, and of leaving 
an important age vacant. It would be interesting to know 
the evidence on which the seven-digit and rhyme tests were 
placed in Age XV. As a matter of fact, the XV-year 
norms, not to mention any others in this revision as well 
as in certain other revisions, are practically worthless. 
Moreover, it is more important to have supplied reliable 
tests for Ages XI, XIII and XIV, than for Age XV and 
for adulthood. 

Of the other revisions, particularly the American, which 
have appeared in rapid succession, it may be said that in no 
case are they based upon the performances of selected 
normal children (however, no one has yet demonstrated 
whether selected or unselected cases should be used) ; in 



PSYCHO-CLINICAL NORMS 225 

one case a revision has been made on the performances of 
feeble-minded persons ; in no case has an extensive number 
of cases been tested in every age that has been revised 
(the one possible exception is Goddard's survey; this is 
entirely commendable from the point of view of the number 
of children tested, but it is vulnerable, I believe, because of 
the narrow-range scheme of testing employed) ; in no case 
have the revisions been based on the testing of children 
who have just passed their birthdays (some six-year-olds 
have been six years and one month, others six years and 
eleven months) ; in no case has the wide-range method of 
testing been used, which I have found essential for pur- 
poses of testing out the accuracy of the placing of the 
tests ;^* in some cases revisions have been made in ages in 
which only fifteen or twenty children have been tested, while 
in other instances age-norms have been revised or supplied 
although not a single child has been tested in those ages. 
This manner of constructing measuring scales may be 
fascinating as an intellectual diversion, and the scales may 
indeed be suggestive and possess certain theoretical inter- 
ests and values ; but I must submit that the serviceability 
of scales thus constructed for the purpose of the practical 
reliable diagnosis of the cases which daily come to the 
clinic is questionable. Superficial work like this is mislead- 
ing and tends to arouse contempt for the slipshod stan- 
dards of scientific work obtaining in this field of applied 
psychology. Worst of all, these scales, because of the 
claims made as to their reliability, are appropriated and 
used by large numbers of uncritical Binet testers who are 
neither psychologists nor scientists, and thereby pupils are 
judged or stigmatized on the basis of unproved assump- 

14 Experimental Studies of Mental Defectives, pp. 21, 28, 55. 



226 MENTAL HEALTH OF SCHOOL CHILD 

tions. Instead of glutting the market with measuring 
scales whose accuracy has not been sufficiently established 
by extensive testing to render them practically serviceable, 
it would be better if the investigator devoted his time to 
thoroughly testing out, standardizing and estabHshing 
age-norms for single tests. It is this type of extensive, 
detailed 'draft-horse' work which is now most needed. 

5. The improvement of mental measuring scales 
involves not merely the standardization of the administra- 
tive procedure, nor yet merely the establishment of reliable 
age-norms for the tests already incorporated in existing 
scales;^^ but it requires the addition of new tests in the 
various age-steps ;^^ the establishment of age-norms for 
half-years for younger children ;^^ the establishment of 
various age-standards throughout the scale for the same 
type of test ; the establishment of normal norms of varia- 
tion in addition to normal norms of performance;^^ and 
the elaboration not only of intelligence scales, but of 
scales, separate or combined, of motor, socio-industrial and 
possibly emotional development, as well as tests, graded or 
otherwise, of the characteristic types of mental disorgani- 
zation which obtain in various disequilibrations and 

15 Pedagogical Seminary, 1911, p. 70ff; Experimental Studies of 
Mental Defectives, p. 56 f. 

16 Experimental Studies of Mental Defectives, p. 56; Alienist and 
Neurologist, May, 1912. 

17 Journal of Educational Psychology, 1911, p. 206. The scheme 
there proposed should read as follows: 'The six-year group will 
include children from five years ten months (beginning of tenth 
month) to six years three months (end of third month), while the 
six and one-half year group will include children from six years four 
months (beginning of fourth month) to six years nine months (end 
of ninth month).' 

18 Alienist and Neurologist, May, 1912; Experimental Studies of 
Mental Defectives, pp. 42, 104f. 



PSYCHO-CLINICAL NORMS 227 

psychoses — tests of orientation, paranoidal or delusional 
trends, memory for remote and recent happenings, etc., so 
that graded and standardized scales may better serve the 
purpose of differential diagnosis. 

The need for tests of conative capacity and emotional 
development is evident. A child's mentality includes more 
than the cognitive function : he is a being who feels as well 
as knows and his life-success often depends on how he feels 
and does. The most satisfactory single measure of a 
child's mentality is undoubtedly the test of his intellectual 
development. This furnishes the best preliminary working 
basis for diagnosing his mental age. But to fix a child's 
mental age fully, we must also have especially graded 
series of tests of motor-industrial performances. 

The number of tests in each age should be increased to, 
say, ten rather than decreased to five, as has been done in 
the recent revisions. It is hazardous to attempt to use 
the scale to mentally diagnose defective individuals on the 
basis of a few deviations or abnormalities. Moreover, 
since individuals of the same age and training vary con- 
siderably in different traits, the scale must be so compre- 
hensive that it will survey a maximal number of funda- 
mental functions — so many that we shall be measurably 
certain of striking a fair average. Several of the tests 
eliminated in the 1911 revision have given such valuable 
insight into the mental condition of epileptic and insane 
defectives that it would be a misfortune to drop them 
simply because they are 'schooly,' or because the capacities 
tested are influenced by training. Indeed, nature and 
nurture are mutually interacting and reciprocating 
factors in the developmental process, whence it is idle to 
attempt to sharply separate tests into those which measure 
nature's dower and those which measure the contribution 



228 MENTAL HEALTH OF SCHOOL CHILD 

made by the environment. The environmental factors 
begin to influence the individual at the very portal of life, 
and practically no child of school age in this country suc- 
ceeds in evading the formal educative influences of the 
school. 

The standardization of the methodological technique is 
a fundamental prerequisite of all scientific work. Tests 
cannot be given or repeated under uniform and controlled 
conditions, particularly not by amateurs, unless the pro- 
cedure is fully set forth, both as to what is permissible and 
as to what is expressly forbidden. Moreover, a standard- 
ized procedure for each test should be followed. I have 
found experimenters who read for the child the reading 
selection for ages eight and nine, instead of requiring the 
child to do the reading. Some tell the child in advance that 
he is expected to reproduce what he reads or what is read 
to him, while others say nothing about this. Some give 
the tests as group, instead of clinical tests, thereby both 
changing the conditions and omitting certain tests in each 
age-level which cannot be given group-wise. Discrepan- 
cies in results inevitably arise from such diversities of pro- 
cedure. Fortunately attempts to standardize the 
procedure have recently been made by several workers. 

Since emphasizing the advisability of testing identical 
traits at various age-levels by the same form of test, and 
thus determining the status of specific individual traits in 
diff'erent individuals in terms of normal age standards,^^ 
this need has been recognized by other writers.^" As I 

19 Pedagogical Seminary, 1911, p. 76f; Experimental Studies of 
Mental Defectives, pp. 8f, 56, 109; Journal of Educational Psychology, 
1913, pp. 224f ; Epilepsia, 1913, p. 368. 

20 Seashore, Journal of Educational Psychology, 1912, p. 50 ; and 
Pyle, same Journal, 1912, p. 95. 



PSYCHO-CLINICAL NORMS 229 

have stated before:"^ 'We know little at present that is 
scientifically accurate regarding the degree or character 
of the physical and mental arrest of our repeaters. We 
therefore stand in need of comprehensive serial graded 
tests of intelligence, so that we may determine not only the 
intellectual age of deviating cliildren, but the nature of 
the mental functions most seriously affected.' A series of 
consecutive tests, each differing somewhat from the others, 
which I have used with various groups of children and 
which can be given once annually for a period of six years, 
are now available. 

The greatest present obstacle to genuine progress in 
psycho-clinical work is the lack of reliable normal mental 
age-norms for the fundamental mental capacities. Until 
these are supplied the work of routine inspection and con- 
sultation will be more or less blind or guideless. There- 
fore, in the present stage of the science, the first concern 
of departments of cHnical psychology in schools, univer- 
sities, psychopathic institutes or institutions for defectives 
should be the establishment of reliable psychical (and 
anthropometric) normal age-norms for individual traits. 
Tliis, I judge, was essentially the view of Smedley, who 
devoted his energies, while he was connected with the 
laboratory of the Chicago schools, toward the estabHshment 
of developmental norms, particularly of an anthropometric 
nature. No one has yet made any systematic attempt on 
an adequate scale to give us normal mental development 
norms, Binet possibly excepted. Nor is it probable that 
reliable age-norms, whether psychological, pedagogical 
or anthropometric, will ever be supplied, unless the work 
is undertaken, intensively and systematically, by a large 

21 Pedagogical Seminary, 1911, p. 82. 



230 MENTAL HEALTH OF SCHOOL CHILD 

research foundation, or unless the work is properly par- 
celed out among the various psychologists in universities, 
normal schools, public schools, psychiatric institutes and 
institutions for defectives. For we shall not be able to 
test existing scales satisfactorily except by wide-range 
testing (Chapter IV), nor shall we be able to establish 
thoroughly reliable norms except by testing multitudes of 
normal children,^^ at the very minimum one hundred boys 
and one hundred girls at each age by years and also by 
half-years in the earher ages. It would be better to set 
the number at five hundred or a thousand for each age. 
That would be a gigantic undertaking, however, requiring 
the concentrated attack of a large corps of trained 
workers, but the ultimate results which this research would 
yield toward the better understanding of children would 
well repay the toil and expense required. 

22 Pedagogical Seminary, 1911, p. 81; Journal of Educational Psy- 
chology, 1912, p. 225f; Alienist and Neurologist, May, 1913; Epilepsia, 
1912, p. 376; Experimental Studies of Mental Defectives, pp. 21, 28, 
55. 



CHAPTER XI 
INDIVIDUAL AND GROUP EFFICIENCY^ 

For ages, men waged wars on purely fortuitous or hap- 
hazard principles. Not until Bismarck and Von Moltke 
instituted, parallel with the line, a military staff organi- 
zation composed of scientific experts, was warfare reduced 
to a science and conducted in accordance with the scientific 
principles of efficiency. The military supremacy attained 
by the German army, after it had been organized in 
accordance with staff efficiency principles, has lately been 
duplicated by the Japanese government through a similar 
organization of its military forces. The modem science of 
national efficiency in its broadest aspects may thus be said 
to owe its inception to the military application of efficiency 
principles in the empire-building campaign of Germany. 

For four or five thousand years men have been building 
houses out of bricks. Successive generations of masons 
have probably laid the bricks in much the same uneconomi- 
cal fashion. The thought that bricklaying could be done 
in strict accordance with a scientific standard of efficiency 
seems not to have dawned upon the world until an efficiency 
engineer of our own day, Frank Gilbreth, demonstrated 
by means of a simple experiment in psychological observa- 
tion and chronometry, that thirteen of the eighteen cus- 
tomary movements in bricklaying were entirely superfluous 

1 Reprinted, with additions, from the Psychological Bulletin, 1913, 
pp. 390-397. 



232 MENTAL HEALTH OF SCHOOL CHILD 

and that, supplied with standardized conditions and stan- 
dardized operations, the output of the average bricklayer 
could be increased from 120 to 360 bricks per hour, with- 
out any material increase in the amount of physical exer- 
tion or fatigue. The modern appUcation of scientific 
efficiency principles to the details of 'shop management' — 
to the utilization of labor, materials, equipment, the details 
of operation and distribution — had its origin in the time 
and motion studies of Frederick W. Taylor in the Midvale 
Iron Works, about thirty years ago, by means of which 
the maximal limit of efficient performance under normal 
and wholesome conditions was scientifically determined. 
This forward movement in human engineering deserves to 
be ranked with the introduction more than one hundred 
years ago of uncarnate power in the place of carnate 
forces, as the instrument by means of which the world's 
labor was to be accomplished. For (although mechanical 
power is decidedly cheaper than man power — from '135 to 
1,350 times cheaper') the scientific studies of occupational 
habits and task schedules have not only multiplied the 
producing capacity of human muscular power three- or 
fourfold, but they have led to the introduction of labor 
systems which have transformed devitalized, mechanical 
toilers into organizers, directors, administrators and con- 
structive forces. 

Begun as a scientific attempt at economic empire- 
building and profitable industrial organization, the effi- 
ciency propaganda has latterly become crystallized into 
a system of efficient psycho-technics, and has grown into 
a national philosophy, a philosophy of conservation and 
efficiency, single in its controlling aim (the elimination of 
waste due to human inefficiency), and all-inclusive in its 
scope. The philosophy is applicable alike to men and 



EFFICIENCY 233 

materials, methods and management, labor and capital, 
employer and employee, line and staff, rank and file, 
lettered and unlettered, producer and consumer, service 
and equipment, processes and plants, natural resources 
and manufactured products, factory and church, school 
and shop, charity and business, nation and state, city and 
corporation, individual and community, unit and group. 

The results of the present-day widespread interest in 
the gospel of efficiency, human and material, are seen on 
every hand: in the incorporation of efficiency planks into 
the national party platforms (conservation of natural and 
human resources) ; in the establishment of national conser- 
vation bureaus (the Children's Bureau) ; in the organiza- 
tion of municipal research bureaus (the Bureau of Muni- 
cipal Research of New York City, Chicago Bureau of 
Municipal Efficiency, the Pittsburgh Social Survey and 
Morals Efficiency Commission, etc.) ; in the establishment 
of departments of heredity or psycho-clinical research in 
institutions for various kinds of mental defectives, juvenile 
courts, public schools and universities ; in the organization 
in the public schools of departments of health supervision 
and child hygiene (unfortunately still largely restricted 
to limited systems of 'medical inspection') ; in the organiza- 
tion of staffs of consulting specialists or efficiency engineers 
in industrial and commercial plants ; in the founding of 
efficiency societies (thus the American Society for Pro- 
moting Efficiency, April, 1912, the National Committee 
for Mental Hygiene, 1912, the American Association for 
the Study and Prevention of Infant Mortality, the Ameri- 
can School Hygiene Association, etc.) ; in the launching 
of efficiency periodicals (thus Human Engineering, Cleve- 
land, 1912 ; The Child, Chicago, 1912), and in the creation 
of a rapidly growing literature, dedicated to the objective, 



234 MENTAL HEALTH OF SCHOOL CHILD 

impersonal, scientific study of the factors or conditions 
which make or mar human efficiency, whether in the indi- 
vidual or in the group. 

In the following pages it is my purpose to review briefly 
the efficiency literature which has appeared during the last 
two years, and which admits of summary under the heads 
which follow : 

1. The conservation and increase of vocational (indus- 
trial-commercial) efficiency/, by means of scientific shop or 
business management. 

In two lucidly written and aptly illustrated volumes, 
Emerson has presented the ablest exposition extant of the 
philosophy of efficient industrial management (9), together 
with a codification of the practical scientific principles 
involved (10). He recognizes that efficient shop manage- 
ment — which depends on the establishment of scientific 
analytical motion and time studies, of time equivalents for 
every operation or task, and the adoption of a standard 
service or labor equivalent for a given wage — cannot be 
instituted without a staff" of consulting experts, consisting 
not merely of efficiency engineers and wage specialists, but 
also of 'character analysts,' psychologists, hygienists, 
physiologists, bacteriologists and economists. While abso- 
lute standards for chemical, physical and electrical pro- 
cesses can readily be set and enforced, human beings must 
be rated, classified and treated as sentient, moral beings. 
Properly to administer men on efficiency principles requires 
the expert services of the psychologist, physiologist, phy- 
sician and humanitarian. Indeed, Emerson avers that, so 
far from being a purely material engineering problem, the 
highest staffs standards are psychological. 'It is psy- 
chology, not soil or climate, that enables a man to raise 
five times as many potatoes per acre as the average of his 



EFFICIENCY 235 

own state' (9, p. 107). Moreover, the science of industrial 
efficiency is an idealistic philosophy, and not merely a cold, 
brutal, calculating scheme for oppressing labor — a fact 
which has been emphasized by Brandeis (3), who argues 
that there is no inherent incompatibility between the claims 
of scientific management and the rights of organized labor. 
Scientific management means the 'square deal' for the 
wage-worker : shorter hours, without 'speeding up' ; more 
regular employment and greater security of tenure; pro- 
portionately higher financial returns ; instruction for the 
inefficient ; and a heightened feeling of self-respect and 
interest in the work. 

That the problem is in part both psychological and 
pedagogical is likewise emphasized by Gantt (the author 
of the 'bonus system' of compensation, which provides 
extra pay for work satisfactorily done in a specified time : 
piece work for the skilled and day work for the unskilled). 
He (11) recognizes the need of a factory pedagogue, who 
must be a keen psycho-analyst as well as an efficient 
teacher. His duties will consist in instructing the work- 
men, in training them to form efficient vocational habits, 
and to acquire habits of industry and willing cooperation. 
The policy of the past was to drive or force the wage 
worker: in the future it must be to teach and lead. The 
whip must be replaced by stimuli derived from skilled 
instruction, merited promotion and a deserved bonus. 

That the new science of industrial efficiency cannot 
justify itself solely by its economic fruits, but must also 
be judged by its ultimate physiological and social effects 
upon the workers, is emphasized by Goldmark (12a), in 
an able and comprehensive digest of the literature bearing 
on 'Fatigue and Efficiency' in industry. (The best psy- 
chological researches, unfortunately, receive no mention in 



236 MENTAL HEALTH OF SCHOOL CHILD 

this voluminous compilation.) Owing to the strong ten- 
dency to exploit the workers which will exist under any 
kind of management, the interests of racial efficiency need 
to be protected by adequate labor legislation. Such legis- 
lation must, in the first instance, be based on scientific 
studies of fatigue. Scientific shop management will have 
to conform to the physiological laws (and psychological, 
forsooth) underlying the industrial life. 

The psychological and pedagogical principles which 
may be utilized to increase business efficiency receive their 
most explicit formulation by the psychologist. Scott 
(19) considers that human efficiency is not solely dependent 
on inherent capacity, but on a number of mental factors 
which it is possible intelligently to utilize by becoming 
familiar with the principles of business and educational 
psychology. Scott discusses a number of psychological 
principles which can be practically applied to increase 
business efficiency, such as imitation, competition, loyalty, 
concentration, wages, pleasure, habit-formation and 
relaxation.^ 

2. The conservation and increase of the efficiency of 
eminent talent, by the scientific. Impersonal, objective 
study and control of the conditioning factors of scientific, 
literary and artistic eminence, fame or genius. 

After a lapse of seven years, Cattell (5) has repeated his 
statistical group study of the most eminent American men 
of science. He has undertaken an analysis of the changes 
wliich have taken place during these years, In the relative 
rank, and In the sectional, state, city. Institutional, pro- 
fessional, sex and age distribution of scientific workers 

2 For a recent statement of the relation of psychology to industrial 
and commercial efficiency see Miinsterberg, Hugo, Psychology and 
Industrial Efficiency, Boston, 1913. 



EFFICIENCY 237 

throughout the country. Among the more important 
furthering environmental factors are geographical loca- 
tion or institutional affiliation, and professional position 
(career). Massachusetts and Connecticut continue to 
maintain their scientific preeminence, while three-fourths 
of the leading scientists are in the teaching profession — 
only three medical men not teaching in medical schools find 
positions in the distribution. 

Cattell's explanation of the fact that only eighteen of 
our 1,000 leading scientists are women as due to an 
'innate sexual disqualification,' is rejected by Hayes (13) 
and Talbot (22), who find the cause in woman's social and 
educational inequalities and handicaps. 

Woodworth (32) finds six or seven factors responsible 
for the fact that the average American standard of 
scientific productivity is below the European level, of 
which the most important is our rapid national, industrial, 
economic and educational expansion. The fields of indus- 
trial, economic and educational promotion, organization 
and administration offer higher financial and social 
rewards, and have thereby attracted our best minds. 

But the fact that Massachusetts and Connecticut have 
produced far more eminent men in proportion to the gen- 
eral population than Virginia, North Carolina or South 
Carolina cannot be accounted for, according to Johnson 
(15), on Woods' hypothesis of the dominance of heredity 
over environment. It is due, as shown by the financial 
school budgets of these states, to the greater expenditure 
of money for educational purposes in New England than 
in the Southern States. 

On the other hand, the Whethams (29), from an his- 
toriometric study by the space method of one-fifth of con- 
secutive names in the British Dictionary of National 



238 MENTAL HEALTH OF SCHOOL CHILD 

Biography, reach the conclusion that able parents have 
able children, provided 'like-to-like' matings occur, as is 
found to be the case among the English administrative 
and peerage classes. The comparative inferiority of the 
progeny of artistic, literary or scientific men is due to the 
fact that these classes of men form chance alliances : they 
do not mate with their likes. The 'like-to-Hke' matings 
thus subserve an important evolutionary function: they 
create a super-class in the general population. 

In this connection note may be made of Stern's recom- 
mendation (20) for the conservation of incipient talent, 
that special-talent classes and a special pedagogy should 
be provided for supernormal children; and of Kiernan's 
contention (17) that the genius is a child potentially 
developed, biologically and psychologically, that he must 
be provided with a favorable environment, particularly 
during the psycho-biological stress periods, and that his 
potentialities must be aided by all-round development and 
not by one-sided stimulation, which will tend to upset the 
instable bio-psychological mechanism. 

One sympathizes with the facts, which are emphasized 
and deplored in current discussions of the super-child or 
super-adult, that we lack at present any satisfactory 
standard of genius (the Whethams, 29), that misconcep- 
tions of precocity are widespread (O'Shea, 18), and that 
the necessity has not always been recognized of clearly 
distinguishing between merit and fame in historiometric 
discussions (Browne, 4). Woods' claim (31) that his- 
toriometry (the objective statistical treatment and relative 
grading of the fame of historical characters) can be 
reduced to an exact science is denied by Browne (4), be- 
cause this would-be science does not possess any historio- 
metric functions of constant value. Tliis is particularly 



EFFICIENCY 239 

true of the adjective method (the ratio of the number of 
adjectives of praise to dispraise), which does not give a 
constant differential value to adjectives of different quanti- 
tative importance. Browne considers the adjective method 
inferior to the space and reference-frequency methods. 

3. The conservation and increase of racial efficiency, 
through eugenical matings, and the elimination of the unfit 
by sterilization or segregation. 

Among the significant studies of the hereditary factors 
involved in dependency, defectiveness and delinquency are 
the family history investigations of Davenport (7) and 
Goddard (12). Davenport voices his disapproval in no 
uncertain terms ('Oh, fie on legislators who spend thou- 
sands of dollars on drastic action and refuse a dollar for 
an inquiry as to the desirability of such action!') of the 
legislative efforts to eliminate the unfit by the enactment 
of compulsory sterilization or anti-procreation laws. He 
favors the milder remedy suggested by segregation. 

Notice should be taken of an attempt to standardize the 
methods of collecting, charting and analyzing hereditary 
data (8). 

4. The conservation and increase of the mental effi- 
ciency of individuals, by means of the removal of physical 
defects {orthophrenics through orthosomatics) ,^ or by the 

3 I would suggest the use of the word orthophrenic to designate any 
process or regimen by means of which deviate mentality may be made 
to function aright; the word orthosomatic to designate any process or 
regimen by means of which any malfunctioning bodily organ may be 
made to work normally; and the word orthogenic as the generic term 
to apply to any orthophrenic or orthosomatic processes of restoring 
deviate human nature to normal functioning. All these processes 
are essentially and specifically pedagogico- or medico-corrective. 
Effectually to apply them presupposes the development of a number 
of highly technical orthogenic sciences. 



240 MENTAL HEALTH OF SCHOOL CHILD 

administration of proper pharmaco- or dietetico-dynamic 
agents. 

Wallin has measured by serial psychological tests given 
throughout a school year the euthenical effects of oral 
treatment and prophylaxis on the working efficiency of 
school children (see Chapter XIII). The contention is 
made 'that the desirability of establishing dental clinics in 
the public schools for free inspection and treatment should 
present itself to the taxpayer as a simple business, if not 
a humanitarian, proposition — the paying of proper divi- 
dends on the capital invested in the schools,' the elimina- 
tion of preventable waste. 

The elaborate series of psychological measurements of 
Hollingworth (14) of the influence of caffeine on various 
mental and motor processes and on the sleep and general 
health of a control squad of sixteen male and female adults 
will serve as a model for similar scientific investigations in 
the future of the somato-euphoric and psycho-orthogenic 
effects of the use of various drugs, foods, dietaries, 
etc. His results indicate that mental efficiency may be 
heightened, without reactionary after-effects, by the 
administration of judicious doses of caffeine in its pure 
form. 

Closely related is 5. The conservation and increase of 
the working efficiency of the school population, of normal 
or abnormal pupils, in elementary, higher, special, rural, 
urban or state institutions, by the scientific study and 
control of the processes and agencies which directly or 
indirectly minister to psycho-pedagogical proficiency. 

Perhaps we may agree with the eugenist that permanent 
racial improvement will come only by improving the inborn 
qualities of men (considered under 3, above). At the 
same time, we are obliged to deal with conditions as we 



EFFICIENCY 241 

find them ; after the human misfits have been bom, we must 
bring them to maximal efficiency by improving the environ- 
mental factors. The most important euthenical agencies 
are the schools, and the training or corrective institutions. 
And it is gratifying to observe that in no field of modern 
enterprise is the efficiency problem receiving greater scien- 
tific study than in the realm of education. Here the major 
studies have been concerned with the attempt to determine 
more accurately than was formerly the case the current 
rate of progress through the grades (thus Blan, 2 ; Keyes, 
16; Strayer, 21); with the introduction of effective 
schemes of varying the rate of progress through the 
grades, so that the needs of the individual pupil may be 
properly conserved (for example, the Mannheim system of 
grade organization. Van Sickle, 25) ; with the attempt to 
differentiate curricula, so as to render them sufficiently 
varied to meet the needs of all types of exceptional children 
(witness the recent organization of special classes, occupa- 
tional courses, elementary industrial, trade and continua- 
tion schools) ; with the effort to establish by diagnostic, 
psychological tests, developmental age-scales of personal, 
social, industrial, motor and intellectual traits for re- 
tarded, average and accelerated pupils, so that pedagogi- 
cal or vocational tasks may be fitly adjusted to the level of 
functioning of each child (thus Wallin's plan for gauging 
the efficiencies of a colony of epileptics, 27) ; with the 
task of estabUshing pedagogical efficiency scores, criteria 
or scales, by which to make an impersonal, objective deter- 
mination of a child's proficiency in various branches of the 
curriculum, such as English composition (Thorndike, 23), 
handwriting (Thorndike, 24; Ayres, 1) and the funda- 
mental operations in arithmetic (Courtis, 6) ; with the 
effort to determine the functional efficiency of various 



242 MENTAL HEALTH OF SCHOOL CHILD 

methods of teaching, such as the incidental or drill method 
of teaching spelling (Wallin, 28, who fails to substantiate 
the claims of Rice and Cornman, and who shows by tests 
that spelling efficiency can be increased by the utilization 
of a psychologically justifiable drill technique) ; and with 
the attempt to determine the best age at which to enter 
children in the schools (Winch, 30, who finds that there is 
no intellectual advantage in entering children at three 
rather than at five in English schools) . 

This survey of the literature on human efficiency — ■ 
necessarily all too brief relatively to the importance of the 
subject — should leave a threefold impression in the mind 
of the reader: first, that the problem of conserving and 
increasing the efficiency of the race is many-sided, present- 
ing many varied and complex phases ; second, that the 
problem is soluble only through the development and appli- 
cation of a distinct scientific technique, sufficiently varied 
and specialized to fit any phase of the problem ; and, third, 
that the problem is too large to be solved by any one type 
or class of existing investigators, but that it requires the 
development of a new type of scientific investigators, 
namely, a cooperative corps of 'efficiency experts' in 
physiology, psychology, education, hygiene, medicine, an- 
thropology, sociology, philanthropy, economy, chemistry, 
engineering and jurisprudence. 

References 

1. AyreSj L. p. a Scale for Measuring the Quality of 
Handwriting of School Children. Department of Child 
Hygiene^ Russell Sage Foundation, New York, 1912. 

2. Blan, L. B. a Special Study of the Incidence of Retar- 
dation, Teachers College, Columbia University, New 
York, 1911, pp. 111. 



EFFICIENCY 243 

3. Brandeis, Louis D. Organized Labor and Efficiency. 
The Survey, 1911, 26: 148-151. 

4. Browne, C. A. The Comparative Value of Methods of 
Estimating Fame. Science, 1911, 33:770-773. 

5. Cattell, J. McK. A Further Statistical Study of 
American Men of Science. In American Men of Science, 
New York, 2d ed., 1910, 564-596. 

6. Courtis, S. A. Standard Scores in Arithmetic. The 
Elementary School Teacher, 1911, 12: 127-137. 

7. Davenport, C. B. Heredity in Relation to Eugenics. 
Henry Holt & Co., New York, 1911, pp. 298. 

8. Davenport, C. B., et al. The Study of Human Hered- 
ity. Eugenics Record Office, Cold Spring Harbor, 
Bulletin No. 2, pp. 17. 

9. Emerson, H. Efficiency as a Basis for Operation and 
Wages. The Engineering Magazine, New York, 1912, 
pp. 254. 

10. Emerson, H. The Twelve Principles of Efficiency. The 
Engineering Magazine, New York, 1912, pp. 423. 

11. Gantt, H. L. Work, Wages and Profits. The Engi- 
neering Magazine, New York, 1911, pp. 194. 

12. GoDDARD, H. H. Heredity of Feeble-Mindedness. 
American Breeders Magazine, 1910, 1:165-178. 

12a. GoLDMARK, Josephine. Fatigue and Efficiency, a Study 
in Industry. Charities Publication Committee, New 
York, 1912. Part I, pp. 288. Part II, pp. 565. (Briefs 
in defense of women's labor laws by Louis D. Brandeis 
and Josephine Goldmark.) 

13. Hayes, Ellen. Women and Scientific Research. 
Science, 1910, 32: 864-866. 

14. HoLLiNGWORTH, H. L. The Influence of Caffeine on 
Mental and Motor Efficiency. Archives of Psychology, 
New York, 1912, 22: 166. 

15. Johnson, G. H. Dr. Woods' Application of the His- 
toriometric Method. Science, 1911, 33:773-775. 



244 MENTAL HEALTH OF SCHOOL CHILD 

16. KeyeSj C. H. Progress through the Grades of City 
Schools. Teachers College^ Columbia University, New 
York, 1911, pp. 79. 

17. KiERNAN, J. G. Is Genius a Sport, a Neurosis, or a 
Child Potentially Developed ? The Alienist and Neurolo- 
gist, serial articles from May, 1907, to February, 1912. 

18. O'Shea, M. V. Popular Misconceptions Concerning 
Precocity in Children. Science, 1911, 34: 666-674. 

19. Scott, W. D. Increasing Human Efficiency in Business. 
The Macmillan Co., New York, 1912, pp. 339. 

20. Stern, W. The Supernormal Child. Journal of Edu- 
cational Psychology, 1911, 2: 143-148; 181-190. 

21. Strayer, G. D. Age and Grade Census of Schools and 
Colleges. Bulletin No. 451, United States Bureau of 
Education, Washington, 1911, pp. 144. 

22. Talbot, Marion. Women and Scientific Research. 
Science, 1910, 32: 866. 

23. Thorndike, E. L. A Scale of Merit in English Writing 
by Young People. Journal of Educational Psychology, 
1911, 2:361-368. 

24. Thorndike, E. L. Handwriting. Teachers College 
Record, New York, 1910, pp. 93. 

26. Van Sickle, J., et al. Provision for Exceptional Chil- 
dren in Public Schools. Bulletin 461, United States 
Bureau of Education, Washington, 1911, pp. 92. 

26. Wallin, J. E. W. Experimental Oral Euthenics. 
Dental Cosmos, 1912, 54:404-413; 545-566. Also, 
Experimental Oral Orthogenics. Journal of Philosophy, 
Psychology, and Scientific Methods, 1912, 9:290-298. 

27. Wallin, J. E. W. Human Efficiency, a Plan for the 
Observational, Clinical and Experimental Study of the 
Personal, Social, Industrial, School and Intellectual Effi- 
ciencies of Normal and Abnormal Individuals. Ped. 
Sem., 1911, 18: 74-84. See also Eight Months of Psycho- 
Clinical Research at the New Jersey State Village for 



EFFICIENCY 245 

Epileptics, with Some Results from the Binet-Simon 
Testing. Transactions of the National Association for 
the Study of Epilepsy and the Care and Treatment of 
Epileptics, 1912, 8:29-43. (Reprinted in Epilepsia, 
1912.) 

28. Wallin, J. E. W. Spelling Efficiency, in Relation to 
Age, Grade and Sex, and the Question of Transfer. 
Warwick and York, Baltimore, 1911, pp. 91. Also, How 
to Increase Spelling Efficiency. Atlantic Educational 
Journal, 1912, 7:225-226. 

29. Whetham, W. C. D. & C. D. Eminence and Heredity. 
The Nineteenth Century, 1911, 69: 818-832. 

30. Winch, W. H. When Should a Child Begin School.? 
Warwick & York, Baltimore, 1911, pp. 98. 

31. Woods, F. A. Historiometry as an Exact Science. 
Science, 1911, 33:568-574. 

32. WooDwoRTH, R. S. On Factors Contributing to a Low 
Scientific Productivity in America. Science, 1911, 33: 
374-379. 



CHAPTER XII 

THE EUTHENICAL AND EUGENICAL ASPECTS 
OF INFANT AND CHILD ORTHOGENESIS' 

The mental and physical health of children is a national 
asset which the state is under obhgation to preserve and 
develop, for the indefinite improvement of humanity and 
the cause of the young child are inseparably interwoven. 
The problem of infant mortality, therefore, cannot be 
viewed apart from the larger problem of race conser- 
vation; and in the final analysis the problem of race con- 
servation involves not only race preservation but a two- 
fold process of human orthogenesis : first, a process of 
physical orthogenesis, or orthosomatics, by which I refer 
to any process through which malfunctioning physical 
organs may be made to function aright, or by means of 
which healthy organs may be continued at normal func- 
tioning, so that the physical organism may develop to its 
maximal potential; and secondly, a process of mental 
orthogenesis, or orthophrenics, by which I refer to any 
process, mental or physical, of righting any malfunction- 
ing mental power, so that the mind may realize its highest 
developmental possibilities. On such a theory, the imme- 
diate purpose of a constructive community program — 
and only a community program will prove genuinely effi- 

1 Read before the American Association for Study and Preven- 
tion of Infant Mortality at the annual meeting in Cleveland, Ohio, 
October 3, 1912. Reprinted from Transactions of the Association, 
1913, 3: 173-194, and from The Psychological Clinic, 1912, pp. 155-173. 



CHILD ORTHOGENESIS 247 

cacious — of race conservation or human orthogenesis, may 
be stated as irreducibly threefold : 

First, salvation; i.e., the salvation of every born babe, fit 
or unfit, from a premature grave. Perhaps it were better 
to follow the example of the Greeks, a nation of ancient 
eugenists, and allow the unfit, provided they could be 
infallibly diagnosed, to perish by exposing them to death 
perils. But this expedient can be dismissed at once, 
because the very thought is abhorrent to the twentieth 
century mind. 

Secondly, improvement; i.e., the maximal uplift or up- 
building, bodily and mental, of every surviving babe, 
whether fit or unfit, so that it may reach its maximal 
potential of social efficiency. The duty to preserve the 
unfit babe, once it is born, implies the duty to provide it 
with that nurture and protection which will bring it to 
its highest estate. 

Tliirdly, elimination; i.e., the eradication of the social 
misfits, not by the impossible expedient of enforced select- 
ive euthanasia, chloroforming or infanticide, but by the 
reduction of the birth rate of the unfit stock, and the 
increase of the birth rate of normal healthy babies. 

If the immediate or ultimate aim of the infant mortality 
crusade cannot be reduced beyond the above triple mini- 
mum, it is evident that a scheme of constructive planning 
must include remedial, corrective and preventive work, by 
the control of environmental and hereditary factors. 
While much of the conflict between the groups of environ- 
mental and hereditary infant welfare workers is due to 
the paucity of demonstrated facts in this field, which 
enables one group to attribute all, or nearly all, the blame 
for infant mortality, or for racial depopulation and de- 
generacy, to environment, while the other group just as 



248 MENTAL HEALTH OF SCHOOL CHILD 

confidently holds heredity responsible;^ yet it is probably 
true that the greater part of the controversy is due to 
one-sided views as to the basal aims to be realized, and 
accordingly the methods to be employed in an infant 
mortality crusade. On the one hand, there are some 
euthenists who limit the legitimate scope of the work to 
the saving of life from premature extinction, and who 
underrate, if they do not entirely neglect, a program of 
subsequent diagnosis, care and training ; while on the other 
hand, there are those who admit that a follow-up program 
of orthogenic reconstruction undeniably possesses value 
for the individual, but insist that it has no beneficent 
influence on race improvement, that permanent race im- 
provement can result only from eugenical breeding, and 
that environment is of minor importance. The student of 
orthogenics, however, regards it as impossible of practical 
achievement and fatal to the realization of the highest 
orthogenic results in the work of race reconstruction, to 
attempt to divorce the above aims, to neglect one at the 
expense of either of the other two, and to create a wide 
gulf between the euthenical and eugenical factors of 
control. 

In the space that remains I purpose to present a brief 
statement of the points of view, claims, evidence and the 
measures advocated by the two schools of infant conser- 
vationist workers, and to offer a few suggestions for a 
fairly comprehensive program of euthenical and eugenical 
work. 

2 Few of the factors productive of infant mortality have been 
studied under thoroughly satisfactory conditions of analytical con- 
trol; hence the value of many of the statistical findings is question- 
able. Yet these discrepant findings are constantly used in support of 
the most divergent claims. There is great need of genuine scientific 
research in this field. Too much of it has been quite pseudo-scientific. 



CHILD ORTHOGENESIS 249 

EUTHENICS 

The euthenist claims that the major percentage of 
infant deaths are due to a maladjusted environment, or 
to detrimental factors which are under environmental 
control. He tells us : 

That the vast majority (some say 90 per cent) of babies are 
well born; 

That adverse environmental influences are not more destruc- 
tive of the biologically inapt than the biologically apt infant; 

That since the hereditary factors exert a minor influence 
during early life, the eugenically fit will succumb during 
infancy quite as readily as the eugenically unfit ; 

That the high infant mortality rate is in part due to the cir- 
cumstance that infancy is the period of most rapid development, 
and the powers of immunity are weakened during the critical 
periods of maximal development; 

That most infants die of preventable digestive disorders 
caused by bad feeding, bad food, food infected particularly by 
the house fly, or by injurious drugs or beverages, and of pre- 
ventable respiratory diseases, caused by bad air and dirt; and 

That, in the final analysis, therefore, the causes of infant 
morbidity and mortality are chiefly sociological, psychological 
and economic, a combination of ignorance, carelessness, indif- 
ference, neglect, filth, vice and poverty. 

Thus it was found in a study of 44,226 deaths under 
age one, in New York, Philadelphia, Boston and Chicago, 
that acute gastro-intestinal disorders were responsible 
for 28 per cent, and acute respiratory diseases for 18.5 
per cent of the deaths (L. E. Holt) ; while the correspond- 
ing mortality figures in England and Wales during the 
period from 1892 to 1901 were 57.5 per cent and 25.3 
per cent, respectively. Of the 49,000 infants who die 
under the age of two every year in the United States from 



250 MENTAL HEALTH OF SCHOOL CHILD 

cholera infantum, it is maintained that the majority are 
poisoned by flies. 

Moreover, the euthenist contends that the real causes 
are often mistakenly or fraudulently reported. Thus 
premature births or still births, which constitute about 25 
per cent of the mortality figures both in England and 
America, and which are alleged to be due to impairment 
of biological capital or neuropathic taint, are often due 
to abortion produced by abortifacients or criminal opera- 
tions, or to infanticide, or to overwork and starvation of 
the mothers (as they are frequently found among factory 
mothers). Likewise in some cases in which the cause is 
reported as parental alcoholism, the inebriety is only 
indirectly responsible for the deaths. Often the real cause 
is overlaying — the crushing or smothering of the infant 
by the narcotized parent. This circumstance seems to 
explain why so many infants die between Saturday night 
and Sunday morning — 42 per cent of 461 cases reported 
in an English study. 

With the emphasis placed on such factors as the above, 
it is evident that the euthenist will look to the control of 
environmental factors for his orthogenic measures. Among 
the control measures wliich may be mentioned are the 
following : 

The complete extermination of the house fly ; 

The establishment of scientific standards of ante- and post- 
natal maternity and infancy nurture and care ; 

Relieving mothers from excessive toil,^ hunger or emotional 
tension before, during and following the period of confinement, 

3 'Women who toil at wearisome work up to the final hour give 
birth to children inferior in weight to those born of mothers who have 
given themselves up to rest and quiet for some time before the 
expected birth.' — Pinard. 



CHILD ORTHOGENESIS 251 

by the establishment of expectant refuges^ lying-in hospitals or 
maternity nurseries, or nursing mothers' restaurants, where 
wholesome food may be dispensed to the mother free of charge 
or at small expense, or by the legislative pensioning or endow- 
ment of motherhood, or by the issuing of a form of motherhood 
insurance ; 

The compulsory registration and periodical inspection of 
baby farms or foundling homes ; 

The licensing and supervision of foster mothers ; 

The establishing of medically supervised milk stations or 
social consultation centers, where properly modified, pasteur- 
ized or sterilized milk may be supplied, and where mothers 
may receive instruction and witness demonstrations in the 
scientific care of infants ; or the establishment of community 
educational health centers of the Milwaukee type, for the 
training of mothers, nurses, social workers, midwives* and 
doctors in infant feeding, care and hygiene, and in home and 
neighborhood sanitation ; 

The establishing of public summer baby tents ; 

The development of measures to substitute breast feeding^ 
for bottle feeding; 

The legal imposition of fines on mothers who can but Avill 
not nurse their sickly babies; 

The substitution by legal enactment of bottle teats for bottle 
tubes ; 

The frequent systematic inspection of the mouths of young 
children adequately to control the 'disease of the people,' 
dental caries ; 

The after-care or supervision of sick children during con- 
valescence ; 

* Our first municipal school for midwives was established in New 
York in 1911. 

5 Children fed at the mother's breast double their weight at the 
end of the fifth month, and treble it at the end of the twelfth month, 
while those bottle-fed double only at the end of the first year, and 
treble only in the course of the second year. 



252 MENTAL HEALTH OF SCHOOL CHILD 

The expert community supervision of infants until they 
statutorily come under the supervision of school boards ; 

The systematic (annual or biennial) examination of pupils 
in the schools by medical and psychological inspectors, vrith a 
view to the discovery and correction of physical disabilities 
and mental deviations or abnormalities ; whether developed or 
latent f 

The community supervision, regulation and socialization of 
urban recreation; 

The education of the youths of both sexes in sex hygiene; 
and 

The education of girls and young wives for motherhood in 
little-mothers' classes or in continuation home schools. 

Concerning the desirability of instituting systematic, 

organized plans for putting into effect some of the above 

measures, there ought to be little difference of opinion. 

There is, at least, little reason to doubt the efficacy of 

many of these measures. To cite merely four instances : 

by the employment of various corrective, remedial and 

preventive measures in New York City the infant death 

rate between 1881 and 1902 was reduced 62 per cent; by 

providing infant supervision by means of district nurses 

the mortality in New York City last year was reduced to 

1.4 per cent among 16,987 supervised babies (the cost of 

the supervision amounted to about fifty cents per child 

per month — the same as in Milwaukee) ; by arranging to 

give mothers a ten-day rest period before confinement 10 

per cent was added to the weight of infants in Paris ; and 

6 The last two measures are partly in practical force in New York 
City (and Boston), where a Division of Child Hygiene, of the Depart- 
ment of Health, has been established under municipal control with 
the duty of supervising the health of children from birth to the legal 
working age. It is some such community organization as this for 
which I shall plead, though I prefer to have it established as a part 
of the public school system, with various additions to its functions. 



CHILD ORTHOGENESIS 253 

bj the simple expedient of feeding infants from the breast 
instead of from the bottle the mortality in various cities 
has been reduced in amount varying from fifteen per cent 
to several hundred per cent. 

Obviously, the first efforts of any organized plan of 
human conservation should aim so to environ every babe 
that it may obtain a decent fighting chance for survival 
beyond the cradle. By the proper control of environ- 
mental factors I believe that we can eradicate 75 per cent 
of infant mortality, provided the work is organized on a 
community basis instead of being left to individual initia- 
tive or direction. Individual effort, because of ignorance, 
caprice, poverty or inefficiency, will mean desultory or 
worthless action, or no action at all. Nothing short of 
organized community action will enable us to eradicate 
the preventable mortality of infants. My first plea, 
therefore, is for the development of comprehensive plans 
on a community basis for preserving and conserving the 
lives of infants. 

But I shall equally lay stress upon a second desideratum, 
namely the organization of community development super- 
vision of the child during the entire growth period. That 
there is need of such supervision in this day of disinte- 
grating homes there can be no doubt. The problem of 
the individual child only begins after the battles of the 
first years of life have been won, and after the child has 
become more or less emancipated from dependence on his 
mother or caretaker. The momentous period of individual- 
ization which now begins is fraught with grave perils at 
every turn. All along, the child will have to cope with in- 
sidious destructive environmental influences which tend to 
abort, deflect or retard his normal development. Can we 
safely entrust the responsibility for normal development 



254 MENTAL HEALTH OF SCHOOL CHILD 

under modern urban conditions to the child or parent ? Do 
not practically all children and most parents lack the 
requisite knowledge, insight and foresight? Is it not, 
therefore, the duty of the community or state to supple- 
ment the home care, and systematically to direct the child's 
development, so that he may come to a true knowledge and 
appreciation of the ideals which the state regards as essen- 
tial to its perpetuity? Clearly it is in the interest of the 
state that the child be so safeguarded from injury and 
disease and so trained that he may reach his maximal 
physical, mental and moral potential, to the end that he 
may become a productive civic unit and not a social drag. 
That the state has already assumed a paternalistic 
function toward her children is shown by the general estab- 
lishment of compulsory systems of public day schools and 
special institutions, and by the more recent establishment 
of systems of school medical inspection. While I am of the 
opinion that the public school systems are the community's 
logical agency for accomplishing the orthogenic work 
required by the infant as well as the child, neither the 
public schools nor the school medical inspection systems 
have as yet been adequately organized to carry out a 
satisfactory program of orthosomatic and orthophrenic 
work. The public schools are making heroic attempts to 
adapt their machinery to the varying physical and mental 
needs of all pupils, but school officers and administrators 
have thus far failed to appreciate that the mental and 
educational problems connected with the mentally excep- 
tional child cannot properly be handled until the direction 
of the work is taken out of the hands of the dilettanti anjit 
placed in the hands of psycho-educational experts, who ,^re 
not only skilled in methods of psycho-clinical diagnosis, 
but who are also capable of functioning as consulting 



CHILD ORTHOGENESIS 255 

experts in the various branches of corrective pedagogy. 
Likewise school medical inspection has failed to deliver, 
partly (1) because many school medical inspectors have 
no specialized training in the diagnosis of the physical and 
nervous defects of children, and lack expert knowledge of 
school hygiene and sanitation and the prevention of 
defects and disorders; partly (2) because the work is 
confined almost entirely to mere inspection and tabulation 
of defects instead of including corrective treatment, with 
the result that in many schools the percentage of pupils 
who actually have their handicaps removed varies from 
5 to 25 per cent;^ and partly (3) because emphasis is 
placed almost entirely on the discovery and correction of 
existent defects, instead of on the discovery and prevention 
of the causes of the defects (that is, the conditions which 
produce adenoids, enlarged tonsils, carious teeth, etc.). 

In order that the schools may serve as an organized 
agency for carrying out an effective program of ortho- 
genic work for every child of school age,^ the following 
plan of work is proposed: 

1. Every child on entering school should be given an 
expert examination for the detection of latent or manifest 
abnormalities of mental, moral and physical development, 
the mental examination to be made by a skilled clinical 

7 In a Chicago school the principal told me that in one of her 
investigations she found that only 5 per cent of the defective pupils 
had taken any measures to have their defects removed. It is said that 
in New York last year, as a result of visits to the pupils' homes by 
inspectors and nurses, 86 per cent of the defects discovered were 
treated. 

8 The schools may well care for the child from the time of birth, in 
the department of orthogenics which I propose. This would entail 
the employment of nurses, who would devote themselves to the care 
of babies and young children. All the records would be filed in the 
one central school bureau. 



256 MENTAL HEALTH OF SCHOOL CHILD 

psychologist who is an expert in psycho-clinical methods 
and in the differential, corrective pedagogy adapted to 
various types of mental deviates ; and the physical exami- 
nation to be made by a physician specially trained in the 
detection of the diseases, the physical defects, the nervous 
disorders and physico-developmental abnormalities of 
childhood. 

2. Children found in these examinations to be mentally 
or physically deviating should immediately receive appro- 
priate orthogenic treatment, whether this be hygienic, 
corrective or preventive, or whether it be physiological, 
pedagogical or psychological. By thus securing diagnosis 
and treatment while the child's brain is plastic we shall be 
able to accomplish the highest orthogenic results. We 
shall be able to prevent the formation of injurious peda- 
gogical habits which result from the malfunctioning of the 
psycho-physical organism and which, once established, are 
often hard to eradicate. To obtain maximal results, the 
child deviate must be classified early. 

3. Specially trained teachers, and special classes or 
institutions should be provided for the mental and physical 
deviates. School medical and dental dispensaries should 
be established for the free treatment of all properly certi- 
fied indigent cases. It is economic suicide for the state 
to pay for the education of pupils who are largely unedu- 
cable because of physical handicaps. To spend large 
sums of money in the discovery of physical handicaps 
without providing the machinery for the rectification of 
defects is also economic suicide. 

4. Physical training should be systematically required 
of every child during his entire school course. Health 
education must be given the same emphasis as mental 
education. 



CHILD ORTHOGENESIS 257 

5. Children shown by the expert examinations and the 
results of special training to be socially and mentally 
incompetent, should be segregated in colonies for perma- 
nent oversight. They should be sent to such institutions 
as soon as their incompetency is measurably certain, at 
least before they reach puberty. No mental incompetents 
should be permitted at large in society, unless the home 
situation is such as to insure adequate protective oversight 
for the child. 

6. The medical and psychological work throughout 
should contemplate not only the discovery and correction 
of defects or deviations which interfere with normal 
development, but also the discovery and removal of the 
conditions, whatever their nature, which produce physical 
or mental disabilities. The keynote of the whole plan must 
be prevention rather than cure. The problem does not so 
much concern the excision of adenoids or enlarged tonsils, 
as the removal of the conditions which cause them. 

There is not space to argue the practical efficacy of a 
comprehensive program of orthogenic work along the line 
indicated above, but reference may be made to the experi- 
ment described in Chapter XIII, which was undertaken 
to discover whether or not the mental efficiency of a group 
of children actually could be raised by orthosomatic mouth 
treatment. The bearing of this experiment — it showed 
that the mentahty of children could be heightened by the 
proper care and use of the oral cavity — is not only 
economic (the financial waste resulting from trying to 
teach pupils whose capacity for development is partially 
blocked by physical disabilities) or moral and humani- 
tarian (the inhumanity and cruelty of forcing children to 
battle through the grades against heavy physical handi- 
caps) but also eugenic. There are probably few physi- 



258 MENTAL HEALTH OF SCHOOL CHILD 

cal defects which do more to impair the constitutional 
vigor of the individual than the insanitary mouth. The 
damage done to the individual by an unhygienic oral 
cavity has been said to exceed the damage done by alcohol. 
Be this as it may, whatever impairs the constitutional 
vigor of the individual will probably, in the long run, 
impair the racial vigor. 

I incline to the unorthodox view that there is a eugenical 
side to euthenical reclamation work. It is possible, I 
believe, by the orthosomatic and orthophrenic work sug- 
gested above, gradually to elevate the vital index of the 
growing generation and thus eventually to improve the 
inheritable qualities of the race. Will not a slow ortho- 
genic transformation of the somatic protoplasm gradually 
produce a beneficent transformation of the germinal pro- 
toplasm, just as the continuous indulgence in alcohol is 
thought by some investigators to produce a gradual 
deterioration of the reproductive cells.'* 

Whether or not this view is scientifically justifiable, I 
want specially to emphasize the following vital eugenical 
aspect of the above community plan of school orthogenic 
work, namely: the truth that the practical efficacy of 
applied eugenics largely depends on the systematic study 
of children in the schools, so that all eugenically unfit 
children may be identified during the prepuhescent years. 
Only through systematic cooperative child study on the 
part of teacher, educator, psychologist, biologist and phy- 
sician will we be enabled to distinguish with certainty be- 
tween the transmissible and therefore eugenically impor- 
tant qualities and the non-heritable and therefore eugeni- 
cally irrelevant qualities, so that our eugenic duty toward 
a given child may be patent certainly not later than at the 
dawn of adolescence. The urgent need for improved 



CHILD ORTHOGENESIS 259 

differential eugenical diagnoses will appear presently. 
But before proceeding further let us summarize the argu- 
ment of the preceding pages : 

It is the inalienable right of every child born into the 
world, whether fit or unfit, to receive such parental and 
community care as shall remedy or prevent sickness and 
disease, and as shall correct or mitigate constitutional or 
acquired physical defects and mental and moral disa- 
bilities, to the end that he may be able to appropriate in 
maximal degree the instruction and training which the 
community bestows upon him, and to the end that he may 
become a fit progenitor of healthy offspring. 

But if this proposition be true, is it not equally true that 
it is the inalienable right of every child to be well born, to 
be saved from impending death, premature decrepitude or 
inaptitude before instead of after birth? Otherwise stated, 
is it not the inahenable right of the state to demand that 
no socially unfit stock shall be born, and to enforce that 
demand by all the police power which it possesses? To 
these questions the eugenist makes affirmative reply. 

Eugenics 

The eugenist affirms that human beings, like the lower 
animals, breed true. Like produces like, fit answereth 
unto fit, unfit follows unfit. Therefore the problem of 
human orthogenics is fundamentally a problem of breed- 
ing viable, untainted infants by means of eugenically fit 
matings. 

If the euthenist has unbounded faith in the efficacy of 
the environment, the eugenist has a no less religious faith 
in his heredity formularies. We are told : 

That the influence of the environment is less than one-fifth, 
nay, less than one-tenth, that of heredity (Karl Pearson) ; 



260 MENTAL HEALTH OF SCHOOL CHILD 

That most infant deaths are due to lack of biological capital, 
or to constitutional inferiority, and the resultant increased 
susceptibility to disease; 

That the issue born of precocious marriages (before the 
parents' organisms have attained their maturity) are bio- 
logically and psychologically inferior ('Sterility often results, 
or children are born with lessened chances of survival. The 
greatest child mortality comes from unions contracted at six- 
teen or earlier, and the lowest from unions contracted from 
twenty-nine to thirty-two.' — Quetelet. 'The heaviest infants 
are born of mothers between twenty-five and thirty.' — Mathews 
Duncan. 'Mothers who at the birth of their first child weigh 
less than fifty-five kilograms and are under twenty years of 
age, have children of inferior weight.' — Schafer. Most 
famous men have been begotten of parents between twenty-five 
and thirty-six years of age) ; 

Short intervals between pregnancies interfere with the 
normal progressive increase in the weight of later births 
(Wernicke) and thus presumably lead to inferior stocks ; 

That 30 per cent of infant mortality is due to inherited or 
congenital syphilis alone; 

That syphilis is the chief cause of abortion; 

That syphilis causes tardy growth in the child {e.g., normal 
children regain their weight at the end of one week, syphilitica 
at the end of two weeks), and sometimes infantilism; 

That the congenitally syphilitic child is far more prone to 
contract the various contagious diseases than the non- 
syphilitic ; 

That more than one-third of tubercular cases in institutions 
come from tubercular families, which it is assumed are tuber- 
cular because of inherited tubercular diathesis ; 

That from 60 to 90 per cent (Tredgold) of the amented 
feeble-minded are hereditary cases, and that a large percentage 
of the insane (16 per cent, Koch), epileptic (56 per cent, Barr 
and Spratling) and criminals and social offenders are the 
victims of heredity; 



CHILD ORTHOGENESIS 261 

That alcohol is a veritable race poison, producing both 
individual and racial degeneracy; 

That parental alcoholism causes atrophy or pathological 
changes of the reproductive mechanism; 

That it is responsible for 5 to 20 per cent of feeble- 
mindedness and epilepsy, 30 per cent of male insanity and a 
large percentage of pedagogical backwardness in school chil- 
dren, for a large percentage of mortality soon after birth, for 
infantilism, deformities, nervous disorders, deficiencies of 
weight and disease in children, and for the inabilty of mothers 
to nurse their offspring (Bunge found that only 2.1 per cent 
of daughters of confirmed drunkards were able to suckle their 
infants) ; 

That female inebriety particularly is a prolific cause of the 
ruin of infant life, inebriety in the expectant mother being 
responsible for a large percentage of sterility, abortion, mis- 
carriages, premature births and still births, and retarded and 
unsymmetrical growth in the embryo (W. C. Sullivan: only 42 
per cent of 600 children of 120 female inebriates lived more 
than two years; 55.8 per cent lived less than two years. 
Lonnett: of 107 English women dying of alcoholism before 
twenty-nine years old, 8 bore no children, 99 bore 6 delicate 
and deformed children; but 29 vigorous children were born 
before the mothers became alcoholic. Some pregnant Swiss 
women alcoholize in order to reduce the size of the child, so 
as to avoid the pains of birth) ; 

That the death rate is greatest for the later pregnancies of 
maternal inebriates (33.7 per cent of deaths among first born; 
72 per cent among the sixth to the tenth born; still births 
among the first born, 6.2 per cent; among last born, 17.2 per 
cent) ; 

That increase in national sobriety has actually been attended 
with a decrease in infant mortality (English study. Latenen's 
study of 20,000 from 5,846 families indicated that the number 
of deaths and miscarriages decreased as the amount of alcohol 
consumed decreased) ; 



262 MENTAL HEALTH OF SCHOOL CHILD 

But that both the number of premature and still births and 
the number of infants who barely escape these conditions are 
increasing in civilized countries (Kaye, whose finding is based 
on English statistics), while likewise our neuropathic stock is 
increasing faster than the general population, so that the army 
of dependents, defectives and delinquents threatens to engulf 
our civilization (one medical alarmist, Kellogg, predicts that 
in the year 2012 no children at all will be born!) ; 

That the preservation of unfit babies by euthenical means 
materially augments the increase of the degenerates ; 

That state systems of granting annual bonuses or allowances 
for each child born are pernicious, because only that part of 
the population which is barely living above the poverty line 
would take advantage of them, and this would tend to augment 
the ranks of the lower social strata ; 

That material prosperity, eugenically considered, is no 
panacea for racial degeneracy, because it tends to produce 
alcoholism, premature debauchery and syphilis (as shown by 
a study of prosperity in the wine-producing canton of Luchon, 
France. See p. 272) ; 

That the potential limits of every individual's level of func- 
tioning are quite definitely fixed by heredity; that since the 
limits cannot be radically altered or lifted by nurture or 
training, each individual will tend to achieve his maximal 
success only in so far as he follows his initial aptitudes, pro- 
pensities or bent; and that therefore the improvement of 
human capacity is primarily a matter of eugenical mating and 
only secondarily a matter of teaching and training. 

What now are the measures which are proposed by the 
eugenist for elevating the standard of parenthood.'' The 
strictly eugenical measures have to do either with the 
regulation of reproduction or mating, i.e., scientific breed- 
ing; or with the protection of the germ plasm from injury 
or deterioration (and possibly with the safeguarding of 



CHILD ORTHOGENESIS 263 

the fetus from injury, starvation or infection). The spe- 
cific measures most frequently advocated are the enforced 
limitation of marriages to the eugenically fit, as deter- 
mined by statutorily required physical and mental exami- 
nations of applicants for marriage certificates ; the com- 
pulsory sterilization, under legal safeguards, of all 
persons adjudged socially incompetent; the quarantining 
of all persons who are carriers of infectious social dis- 
eases ; and the permanent sequestration in state colonies 
of all the epileptic, insane and feeble-minded, chronic 
inebriates, syphilitics, rapists and sexual perverts. 

The student of orthogenics finds himself in sympathetic 
accord with the fundamental aims of the eugenic move- 
ment. In our efforts to fashion a race of human thorough- 
breds nothing less than the eugenical ideal is wholly satis- 
fying. Moreover, we have a right to judge any proposed 
euthenical measure in the light of the eugenical ideal. Any 
euthenical measure which is manifestly anti-eugenical 
should not be encouraged. Legislators may well pause 
before favorably considering those measures now being 
advocated in various civilized nations which are threatened 
with depopulation. The probable immediate effect of 
paying bounties out of the public treasury to mothers for 
the support of babies would be the increase of neuropathic 
stock, so that society would ultimately succumb under the 
ever increasing burden. But while the eugenical concep- 
tion is impregnable as an ideal, the student who is seriously 
interested in the cause of eugenics must recognize that 
there are almost insuperable difficulties in the way of the 
effective application of its principles, and that progress 
in the work will depend upon the measure in which these 
difficulties are successfully overcome. We may group these 
difficulties into four classes : 



264 MENTAL HEALTH OF SCHOOL CHILD 

1. Psychological and sociological difficulties. 

Effective reform of human practices is scarcely possible 
without the aid of the emotional forces of human nature. 
But man's emotional development has not kept pace with 
his intellectual progress. Emotionally, human nature is 
very much the same today that it was in the days of 
primitive man. This is explainable on the assumption that 
the emotions are merely the subjective side of the instincts, 
and instincts are relatively fixed. Therefore, in trying to 
transform the sex life of the race we are obKged to deal 
with a set of emotions which are connected with one of the 
three oldest and most basal instincts of the race, namely 
the sexual instinct. Now, it is at least supremely difficult, 
if not utterly impossible, suddenly to change instinctive 
racial reactions by mere instruction, demonstration, exhor- 
tation or legal enactment. An instinct has become deeply 
imbedded in the very fabric of the psycho-biological life 
of the individual as a result of age-long racial conflicts, 
by slow and painful processes of elimination and survival. 
Therefore, instincts have acquired a degree of stability, 
pertinacity and emotional intensity which renders them 
almost invulnerable to merely rational appeal, and which 
leaves but one way to transform them, namely the evolu- 
tionary method of gradual elimination and survival. 

To illustrate : as a result of thousands of years of pain- 
ful tribal struggle and warfare those tribes were gradually 
selected for survival which abandoned the practice of con- 
sanguineous marriage and incestuous intercourse between 
near relatives. Through painful experience the inexorable 
truth was slowly forced into the consciousness of the race 
that such unions weakened the stamina of the tribe, and 
therefore must be rigorously interdicted. Not only did 



CHILD ORTHOGENESIS 265 

such practices arouse the disapproval, contempt and con- 
demnation of the organization, but they gradually awak- 
ened in the individual a feeling of disgust which in time 
became instinctive. The intense repugnance which the 
normal mind today feels toward consanguineous or incestu- 
ous intercourse rests more upon an instinctive than a 
rational basis. The taboo pronounced on such unions as 
these is founded on the deepest psychic subsoil of the racial 
consciousness, and has become incorporated in the very 
habitudes, customs and traditions of the race, obtaining 
thereby a sanction which is more authoritative than that 
conferred by command or arbitrary legal enactment. 

The eugenic problem would be easily solved if there 
existed a racial instinct of repulsion against anti-eugenical 
matings — if there were a universally instinctive taboo on 
marriages between the biologically unfit. It is a question 
whether such a feeling of disgust, instinctive in its ele- 
mental intensity, can be instilled into the consciousness of 
lovers by mere teaching, enlightenment or prohibition. 
Sexual attraction is an instinctive psycho-biological phe- 
nomenon less subject to regulation by scientific or legal 
prescription than by blind impulse, custom, tradition or 
convention. Most free matings will be determined by 
certain intangible secondary sexual characteristics, certain 
fetiches peculiar to each individual, while the restricted 
matings will be determined by the conventional require- 
ments of social station and wealth — unless, indeed, the 
eugenic creed can be transformed into a vital, national 
religion. 

Just as there are deep-seated psychological instincts or 
emotional forces which tend to frustrate the enforcement 
of eugenic marriages, so the racial instinct of sexual 
modesty will offer the hardest obstacle to the effective 



266 MENTAL HEALTH OF SCHOOL CHILD 

and universal enforcement of laws requiring health exami- 
nations before marriage licenses may legally be issued. 
Even if such laws were generally enacted, will not the 
forces of sex frequently overleap all legal restraints and 
defy prisons and chains? 

In the same way, the chief obstacles to the legal en- 
forcement of the practice of vasectomizing the unfit are of 
a psychological nature — various sentiments and preju- 
dices, and man's instinctive recoil against any interference 
with the processes or impulses of nature. If it were possi- 
ble to vasectomize the whole army of misfits, and to stop 
entirely the manufacture of alcohol throughout the earth, 
the problem of eugenics would be largely solved. The 
chief obstacle against the total elimination of the liquor 
curse, again, is also psychological — the instinct of appe- 
tite and certain mental states which are induced by the 
consumption of narcotics. 

Finally, there are the maternal instinct and filial ties to 
thwart any effective plan of colonizing without exception 
all degenerates or eugenical misfits. 

It has been necessary thus to emphasize the fact that 
there are certain psychological forces, certain instincts, 
emotions, customs, conventions and folk ways, which are 
anti-eugenic in nature, and which must be reckoned with in 
any well-conceived plan of eugenics. The fact that these 
eugenically hostile forces exist in the very citadel of 
humanity makes it all the more essential that the eugenist 
wage a relentless campaign for the increase and dissemina- 
tion of verifiable and convincing knowledge of heredity, so 
that eugenic truths may lay hold on the deepest feelings 
and sentiments of the race and become in fact a national 
faith, tradition or religion. Then will it be possible to 



CHILD ORTHOGENESIS 267 

make eugenic enactments on the statute books genuinely 
effective. 

2. Adrmnistrative and legal difficidties. 

The adequate enforcement of eugenical measures in the 
present stage of civilization requires much governmental 
machinery. But because of the facts which we have just 
considered, it is not probable that adequate laws can be 
secured, or can be enforced if secured. Public sentiment 
would not support the enormous legislative levies which 
would be needed to colonize the vast army of misfits 
(already in New York from one-fifth to one-seventh of the 
state revenues go to the support of the institutions for 
defectives) ; and the popular outcry, based on prejudice, 
blind emotion, impulse or instinct, against the sterilization 
of at least all those misfits who remained at large in 
society, would nullify the law. As a consequence, a large 
number of degenerates would always be found in society 
polluting the race stream. Compulsory physical and 
mental examinations of all parties to marriage contracts 
would serve a useful eugenic purpose ; but the laws would 
be powerless to prevent a man or woman from contracting, 
say, contagious venereal diseases after the bill of health 
had been issued. After all, the problem is not so much to 
get proper laws enacted as to secure the public sentiment 
which will demand their enforcement. There is no remedy 
for these difficulties, except a campaign of discovery and 
diffusion of eugenic facts, so that the public conscience may 
eventually be stirred. 

3. Diagnostic difficulties. 

Our third obstacle is the lack of a reliable or infallible 
criterion of eugenical unfitness, or of anyone competent 



268 MENTAL HEALTH OF SCHOOL CHILD 

to pronounce infallibly on all but the obvious cases. Who 
is competent to decide whether or not a given individual 
possesses desirable or undesirable hereditable determiners? 
Who is able to say unequivocally that a given individual 
is eugenically defective and that he can only give issue to 
tainted progeny? Who can determine with scientific 
exactness that certain determiners are lacking in 'x' and 
that the same determiners are likewise lacking in his 
intended consort? Who is able to determine whether a 
so-called normal person may not be the carrier of defect- 
ive strains, just as healthy persons may be disease carriers, 
whereby unions between such normals may be just as 
non-eugenical as unions between obvious degenerates? It 
must be confessed, I believe, that the gaps in our knowl- 
edge of the laws of human heredity from the biological 
side are still deplorably wide. As far as concerns the 
psychological identification of mental defectives, our 
present technique enables us to locate the extreme types, 
but not the borderland cases. One of our best schemes of 
mental classification is the Binet-Simon scale. But after 
having personally used this scale almost daily for three or 
four years in the study of the feeble-minded, epileptic, 
insane, juvenile delinquents and backward children, I am 
free to confess that while the great utility of the scale 
cannot be questioned, it is not by any means the marvelous, 
unerring machine which it is claimed to be by certain 
overzealous exploiters, even for the purpose merely of 
measuring the degree of mental arrest. Nevertheless, with 
improved measuring scales of intellectual capacity, sup- 
plemented by the scales of personal, social, motor-industrial 
and pedagogical efficiency (see Chapter VI), and by 
developmental and heredity case-studies, the difficulties 
pertaining to the accurate diagnosis of mental cases will 



CHILD ORTHOGENESIS 269 

probably not prove insuperable. The establishment of 
adequate, reliable mental development scales is a large 
task, which cannot be done within a reasonable time with- 
out liberal pubhc or private subsidy. One of the reasons 
for supporting such work is the extreme feasibility of 
experimentation in heredo-psychology. In the psycho- 
logical field it is easy to test and experiment on fit as well 
as unfit individuals, while in the biological field human 
heredity experimentation is almost impossible. This 
brings us to the statement of the final obstacle confronting 
applied eugenics, namely : 

4. Experimental Sfficulties. 

If it were possible to apply the principles of experi- 
mental genetics to human breeding as those principles are 
now applied to the breeding of domestic animals, many of 
the controverted problems could be brought to a fairly 
expeditious adjudication. Just because this seems impos- 
sible of achievement, the propagandist must beware lest 
he bring disrepute upon the eugenics movement by advo- 
cating precipitate, ill-advised or premature action. There 
is danger that zeal may get the better of wisdom, and that 
state and national laws may be passed which we shall 
later come to rue. In the absence of experimental demon- 
stration, who shall say that the laws of human heredity 
are Mendelian and not Galtonian in character .-^ What 
warrant is there for affirming that such socially significant 
complex mental traits as honesty, courage, virtue, initia- 
tive, concentration, perseverance, intelligence, judgment, 
reasoning, kindness and loyalty are unit characters and 
are transmissible as simple determiners? Woods affinns 
that they do not behave as unit characters and are not 
transmissible as such. But it is just such mental char- 



270 MENTAL HEALTH OF SCHOOL CHILD 

acters as these that it is important to transmit, for fun- 
damentally the difference between a social fit and misfit is 
a difference in mental qualities ; the age of brute or muscu- 
lar force has been superseded by the age of intellectual or 
psychic force. 

Since the important question, therefore, is to determine 
whether socially significant complex human mental traits 
are heritable, and since this cannot be directly determined 
for man by the method of experimental genetics, what is 
to be done? The following brief outline of both practical 
conservational and eugenical research work is suggested: 

1. Conservational bureaus or agencies should be estab- 
lished on a community basis, in the cities and common- 
wealths, for the purpose of scientifically supervising the 
health, growth, hygiene and educational development of 
the child from birth to the period of late adolescence. A 
community plan of this character has already been 
sketched in the earlier section of the chapter. I incline to 
the opinion that the work should be organized in connec- 
tion with the public school systems, not merely because this 
public agency is already in existence, nor because it would 
prevent the duplication of material plants, nor yet be- 
cause the people have confidence in the public school 
systems ; but because I believe that the integral function 
of the public schools is not only instruction or training 
but also the conservation of the mental, moral and physi- 
cal health of the children entrusted to their care. 

2. One of the specific functions of this bureau, or of 
some other organization, should be the biographical chart- 
ing of all babies bom into the world, or at least of all 
infants of presumptively degenerate stock.® The bio- 

9 Mothers should be trained to keep maternal diaries of children 
from the time of birth. 



CHILD ORTHOGENESIS 271 

graphical charts, on which the first entries should be 
made shortly after birth, should contain such facts as the 
following: date, order, circumstances, condition, weight 
and height at birth; the mental, socio-moral and physical 
condition, eating and drinking habits, overwork and acci- 
dents of the mother before and at the time of birth; the 
state of health, habits, etc., of the father at the time of 
the conception ; a record of the hereditary factors in the 
direct and indirect ancestral lines ; a statement of the 
housing and environmental conditions. Later entries 
would indicate whether the child was breast or bottle fed, 
and for how long, whether he was properly nourished, 
clothed, disciplined and protected from moral and physical 
injury during childhood, and contain a record of his dis- 
eases, physical defects, accidents, annual anthropometrical 
indices, developmental retardations or accelerations, mental 
and physical peculiarities or abnormalities. This card, or 
a duplicate, should accompany the child to school, where it 
would be properly filed and where it would be supplemented 
by annual entries made by the teachers, the school nurse 
or social worker, the school psychologist and physician. 
These entries would show the child's physical and mental 
condition, as determined by anthropometric, medical and 
psychological tests, and his pedagogical progress from 
year to year. The data thus secured (to be made avail- 
able only to the officers of instruction, diagnosticians and 
research workers) would enable us scientifically to trace 
pedagogic facts and child problems to their real ante- 
cedents, they would be of value for the intelligent guid- 
ance, care, development and training of the child, they 
would enable us to locate and diagnose more speedily and 
effectively the social incompetents, they would contribute 
material of great value to the science of human eugenics. 



272 MENTAL HEALTH OF SCHOOL CHILD 

and would likewise possess considerable value for the guid- 
ance of the child himself after he has reached his majority. 

3. A number of specific medical, psychological, peda- 
gogical and anthropometric investigations, because of 
their practicability and the light which they will shed on 
various eugenical factors, should be prosecuted on a large 
scale. For example: what is the difference in the rate of 
mental and physical development between children of alco- 
holized or cafFeinized or narcotized parents and children 
of abstainers from alcohol and caffeine and tobacco? If 
there is a difference, does it appear during early childhood, 
during early adolescence, or later? Do the differences 
gradually disappear, so that both classes of children 
eventually reach their normal type, just as some species of 
animals whose development has been artificially or experi- 
mentally retarded later recover their losses? 

Likewise, what is the relation between narcotized parent- 
age and mental and physical defects, deformities and 
abnormalities and arrested epiphyseal development in the 
offspring? To answer these questions extensive serial 
psychological, anthropometric, physiological and radio- 
graphic tests need to be made of children of alcoholized 
and non-alcoholized parentage. 

A number of studies already made indicate that this is 
a fruitful field for protracted research. Thus in some of 
the special classes in London and Birmingham 40 per cent 
of the pupils are reported as having intemperate parents, 
while the corresponding percentage for pupils of the same 
age in the regular classes was only 6 per cent. Of like 
tenor is the reported fact that in some cantons in France 
the schools have been flooded with an army of laggards 
seven years after good wine years. 

In an investig-ation carried out on the students of Mur- 



CHILD ORTHOGENESIS 273 

doch Academy, in Utah, it appeared that the offspring of 
non-narco-stimulant parents were superior to those of 
the stimulant parents in all of the twenty-two mental and 
physical traits examined; that as the amount of caffeine 
consumed daily was increased there was observed a pro- 
gressive deterioration in the height, weight and bodily 
condition of the offspring; that the mental and physical 
inferiority was increased when the parents used both 
coffee and tea, when the}^ used tobacco and particularly 
when they used alcohol also; 79 per cent of the narcotized 
parents had lost one or more infants, while only 49 per 
cent of the abstainers had suffered such losses. It required 
from eight-tenths to one year longer for the narcotized 
progeny to graduate from the grades, and their average 
age was one year and seven months older in the academy.^*' 
A parallel study^^ of the effects of coffee drinking by 
children on their own development enforces a conclusion 
previously reached, that a sharp separation cannot be 
made between the eugenical and euthenical aspects of 
various environmental factors. Statistics were compiled 
for 464 children in two schools for a period of one month. 
The drinkers averaged from one and one-half to four 
pounds less in weight,^^ one-half to one inch less in height, 
three pounds less in strength of grip, 2.3 per cent less in 
conduct as concerns those who drank one cup only per 
day, and 7.8 per cent less as concerns those who drank 
four cups or more. The rank in lessons was from 2.6 per 

10 Cf. J. E. Hickman. Journal of Philosophy, Psychology and 
Scientific Methods, 1912, 9: 234. 

11 Charles Keen Taylor. Effects of Coffee Drinking upon Chil- 
dren, The Psychological Clinic, June 15, 1912, p. 56f. 

12 In order to obtain light jockeys the practice is said to obtain 
in England of having boys indulge in liberal quantities of alcohol. 



274 MENTAL HEALTH OF SCHOOL CHILD 

cent less, up to 29.6 per cent less for those who drank 
four or more cups. 

Bj prosecuting on an adequate scale standardized 
researches in heredo-psychology, heredo-pedagogy and 
heredo-biology, analogous to those to which reference has 
been made above, we shall eventually secure the ground- 
work of facts needed by both euthenics and eugenics in 
order that they may attain the dignity of authentic 
sciences. 



CHAPTER XIII 

EXPERIMENTAL ORAL ORTHOGENICS: AN 

EXPERIMENTAL INVESTIGATION OF THE 

EFFECTS OF DENTAL TREATMENT ON 

MENTAL EFFICIENCY^ 

Little if any attempt has hitherto been made to measure 
by scientific, objective means the mental improvement 
resulting from the correction or removal of the various 
physical defects which are now generally known to afflict 
very many school children. We believe that adenoids, 
hypertrophied tonsils, nasal obstructions, defective ears, 
eyes and mouths interfere with normal mental functioning, 
but no one has attempted to determine experimentally the 
precise orthogenic effects which should ensue from a 
definite course of combined prophylactic and operative 
treatment. 

In the present chapter we shall give a very brief sketch 
of the results of an attempt to determine by controlled, 
objective, mental measures the influence of hygienic and 
operative dental treatment upon the intellectual efficiency 
and working capacity of a squad of twenty-seven public 
school children in Marion School, Cleveland, Ohio (ten boys 
and seventeen girls), all of whom were handicapped, to a 

1 Read before Section L, Education, of the American Association 
for the Advancement of Science, Washington, December 39, 1911. 
Reprinted, with alterations, from the Journal of Philosophy, Psy- 
chology and Scientific Methods, 1912, 290-298. 



276 MENTAL HEALTH OF SCHOOL CHILD 

considerable degree, with diseased dentures or gums and an 
insanitary oral cavity.^ These children were the recipients 
of free dental treatment at the hands of the Cleveland 
Dental Society and the National Dental Association 
during the first few months of the experimental year, which 
began in May, 1910, and closed in May, 1911. The treat- 
ment included not only the carpentry of carious teeth 
(that is, the filhng of dental cavities, the extraction of 
decayed roots, the cleaning of the teeth and correction 
of irregularities and malocclusion) and the sanitation of 
the oral cavity, but it also consisted in teaching the chil- 
dren how properly to brush their teeth after each meal 
and how to keep them free from deposits, how to harden the 
gums and how to fletcherize the food; for oral euthenics 
contemplates not only mouth sanitation and the repair and 
polishing of the teeth, but the thorough insalivation and 
mastication of the food. Verbal instruction and demon- 
strations relating to mouth hygiene and correct eating 
habits were given by the then chairman of the Oral 
Hygiene Committee of the National Dental Association 
during two demonstration meals which were served to the 
experimental class at the school. Follow-up work was 
done by an employed nurse, who gave individual advice and 
instruction to parents and pupils, and made it a point 
to ascertain whether the pupils were faithfully following 
the instructions. 

This research was the outgrowth of the nation-wide 
school oral-hygiene campaign inaugurated in Cleveland 
in March, 1910, by the National Dental Association. My 
own connection with the movement consisted in suggesting, 

2 A more complete discussion of this research appears in my 
Experimental Oral Euthenics, The Dental Cosmos, April and May, 
1911, pp. 404ff. and 545ff. 



ORAL ORTHOGENICS 277 

contriving and giving (in person or by proxy) five series 
of psychological efficiency tests at stated intervals during 
the experimental year. These tests were designed to 
measure any improvement or increase which might result 
from the practice of the oral hygiene regimen sketched 
above, in the power of immediate recall (immediate visual 
memory span), in the capacity to form spontaneous and 
controlled associations, in the ability to add, and in the 
ability to perceive, attend and react to, certain visual 
impressions. 

In the memory test the pupils were required to memorize, 
during a period of forty-five seconds, as many figures as 
possible. Ten figures, each containing three digits, in 
large print on a cardboard were displayed before the 
class. Exactly one minute was allowed for writing. This 
test is thus based on the use of non-sense materials and 
furnishes a measure of the capacity to memorize digits. 

In the spontaneous association test, the pupils were pro- 
vided with a sheet of paper containing a column of thirty 
simple, everyday words. At a given signal they were told 
to turn the papers right side up and write opposite each 
word the first word suggested by it, irrespective of whether 
or not the suggested word was logically connected with 
the supplied antecedent or key-word. The time allowed 
was eighty-five seconds. The number of words written in 
a test like this furaishes an index of the speed of ideating 
or of forming free-word associates in connection with 
supplied antecedents — or, in other words, of the speed of 
thinking. 

To measure the speed of forming controlled associations 
an antonym test was employed. In this, the pupils were 
supplied with a sheet containing a column of twenty-five 
key-words, opposite each of which they were instructed to 



278 MENTAL HEALTH OF SCHOOL CHILD 

write (during eighty-five seconds) only that word which 
has the opposite meaning: e.g., better— worse ; sunrise — 
sunset. This test requires intelligent discrimination and 
demands a higher degree of associational efficiency than 
that required in the previous test. 

In the test on the speed and accuracy of adding, the 
pupils were supplied with a sheet containing thirty-two 
columns of figures, each column consisting of ten one-place 
digits. They were told to add as many columns as possible 
within the time limits (two minutes) without stopping to 
re-add any of the columns. This test gives a measure of 
the ability to form controlled numerical associationSo 

In the attention-perception test (A-test) a sheet was 
provided containing twenty-six lines of capital letters. 
The letters were printed entirely promiscuously instead of 
in proper alphabetical order. The pupils were told to 
start at the left end of the top line and proceed to draw a 
line through as many of the A's as possible within the time 
limits (100 seconds). They were specially cautioned not 
to skip any A's or to cross out any other letters. This test 
gives a measure of the speed and accuracy of perceptual 
discrimination, of the power of sustained attention, and, 
secondarily, of the speed and accuracy of manual reaction. 

These five tests thus explore some of the fundamental 
mental traits or capacities. In all tests, and in all sittings, 
the pupils were uniformly urged to do their very best. A 
system of quantitative and of combined quantitative and 
qualitative scoring was worked out for each test.^ 

In order that tests of this character may be used as 
measuring rods for gauging the increased functional effi- 

3 See reference on p. 276, and the instruction sheets which are 
supplied with the complete set of test blanks by C. H. Stoelting Co., 
121 North Green Street, Chicago, 111. 



ORAL ORTHOGENICS 279 

ciency resulting from a given euthenic or corrective factor, 
or factors, a number of essential conditions must be 
supplied. 

First, each of the tests must be constructed in sets or 
series, so that some of the tests may be given before the 
treatment begins, and some during the course of the 
treatment, or after its close. In this investigation each 
test was arranged in six sets, numbered from 1 to 6. Tests 
1 and 2 were given before treatment began. The average 
of these two pre-treatment tests, therefore, represents the 
pupil's initial efficiency, or his normal standard of per- 
formance. The last four tests were given during the 
course of the treatment, or after its close, so that the 
average of these represents the pupil's terminal efficiency. 
The difference between the two averages accordingly 
represents the gain (index of improvement) made during 
the course of the experimental year. Or, instead of taking 
the average of the last four tests for the final efficiency, 
we may substitute the average of the last two. This plan 
seems preferable, because the last two tests were given 
from three to five months after the dental treatment had 
been completed for all the pupils, while tests 3 and 4 were 
given only one or two months after the beginning of the 
treatment for more than half of the pupils. Sufficient time 
had, therefore, not elapsed to allow the orthogenic effects 
to become operative, at least not in maximal degree, at the 
time of the third and fourth tests. 

Second, the sets must be so constructed that all of the 
successive tests in the same set are uniformly difficult, 
although the material must be differently arranged. That 
is, tests number 2, 3, 4, 5 and 6 must be of the same diffi- 
culty as test number 1. Manifestly, if each of the succes- 
sive tests diminishes in difficulty, the increased efficiency 



280 MENTAL HEALTH OF SCHOOL CHILD 

shown is spurious or largely exaggerated. Contrariwise, 
if each successive test increases in difficulty, the actual 
improvement will be minimized or counteracted. Consider- 
able pains were taken to make all the tests of a given set 
equi-difficult. Elsewhere evidence has been adduced to 
show that the tests were fairly uniform in difficulty, while 
the material was differently arranged in every successive 
test. 

Third, the conditions of giving the tests must be 
strictly uniform in all the successive sittings. These con- 
ditions refer to the character of the explanations, the use 
of incentives or suggestions, the constant putting forth of 
maximal effort by the examinees, the withholding of assist- 
ance or fore-knowledge of the test materials, the seating of 
the pupils, the hour of the day used for testing, the time 
allowed for the tests, and the employment of uniform super- 
visory conditions. Moreover, the pupils must continue 
their school work in their usual classrooms,^ and the school 
work should go on as before. A scrupulous attempt was 
made in this research to realize these requirements. 

Fourth, to place the results upon a strictly comparable 

basis, a second squad of untreated children should be given 

exactly the same tests under precisely the same conditions. 

These children should come from the same social strata as 

I the treated children, should approximately be of the same 

I ages and suffer from the same degree of physical handicap. 

I By means of the data obtained from such an untreated 

j squad we should be able to determine the amount of im- 

I provement which is due to such contributing factors as 

\- familiarity, habituation, practice and natural develop- 

4 One of my critics assumes that the pupils were schooled in a 
'small class.' This assumption is entirely without foundation. The 
pupils remained in their regular classrooms. 



ORAL ORTHOGENICS 281 

ment (merely growing older), and the share which is solely 
due to the application of the orthogenic factor under con- 
sideration. Unfortunately it was not possible for me to 
get such a squad as this organized during the experimental 
year. 

Fifth, and finally, the factor, or factors, whose ortho- 
phrenic influence is to be measured must be investigated 
under 'controlled conditions.' One must make certain that 
the factor is constantly operative in the treated squad, 
and that it is inoperative in the untreated squad. In this 
investigation the oral hygienic measures were subject to 
a fair degree of control. It was the duty of the employed 
nurse to see that the pupils conformed strictly to the 
requirements. 

What, now, do the results show with respect to the 
influence of the dental treatment upon the working effi- 
ciency of the pupils? In attempting to answer this main 
question we shall also refer briefly to a number of acces- 
sory facts brought out in the investigation. One of these 
facts is the circumstance that while the boys manifested a 
higher degree of efficiency than the girls in all tests except 
the perception test, the indices of improvement were about 
the same for the two sexes, whence the boys' manifest 
superiority in the efficiency scores is not paralleled by a 
corresponding superiority in the improvement indices. 
Similarly, the amount of improvement was about the same 
for the older and younger pupils, a result not entirely in 
accordance with expectation, for it is currently believed 
that the benefits derived from the correction of physical 
defects are greater the earlier the treatment is applied. 
This is believed to be true particularly as regards naso- 
pharyngeal obstructions. But so far as the mal-eff^ects of 
dental defects are concerned we are unable to find any 



282 MENTAL HEALTH OF SCHOOL CHILD 

significant age differences. Pupils between the ages of 
eleven and fifteen appear to profit in equal degree, irre- 
spective of sex, from the broad application of the principles 
of mouth hygiene. 

On the other hand, the individual differences between 
the pupils in all tests are significant. The differences are 
quite as large as the differences frequently brought to 
light in other psychological and pedagogical experiments 
on pupils of the same age or school grade. Some pupils 
show a high degree, others a low degree, of proficiency; 
and some pupils make marvelous gains while others gain 
very little, or not at all, or actually lose in efficiency. It 
is therefore apparent that experiments of this sort, which 
are based on only a few pupils, are at best only suggestive, 
and that valid inferences or conclusions must be based on 
the central tendencies or average results of a considerable 
number of pupils. 

Not only do we find these large individual differences in 
the efficiency scores and improvement indices, but the fact 
that a pupil gains much in one test does not warrant the 
belief that he will gain much in all the other tests. Quite 
the reverse may be the case. Thus a list of the five pupils 
who made the smallest improvements in each of the five 
tests, was found to contain nineteen of the twenty-seven 
pupils, while the list of the five pupils who made the 
greatest gain in each of the five tests, included thirteen 
pupils. But not a single pupil was enumerated among the 
five poorest in all the tests, nor was a single pupil enumer- 
ated among the five best in all the tests. On the other 
hand, eight of the pupils, ranking with the five poorest 
gainers in one test or another, also ranked with the five 
best gainers in one test or another. While two of these 
showed little improvement in two tests, they, nevertheless, 



ORAL ORTHOGENICS 283 

made large gains in two tests. It is thus apparent that 
many pupils who gain little in some tests may improve 
remarkably in others. But it is worthy of remark that 
only one of the three pupils who were enumerated among 
the best gainers in three or more tests was included among 
the poorest gainers, while none of the three who were 
among the poorest in three tests took rank with the five 
best in any of the five tests, so that there is a certain 
amount of correlation between the indices of improvement 
in the various tests, justifying the conclusion that pupils 
who improve very slowly in several tests will not take place 
with the best ground-gainers in any of the tests. Such 
pupils are probably suffering from general impairment or 
marked retardation. But teachers must recognize that a 
child who gains little along one line of mental activity may 
be developing normally, or even supemormally, along other 
lines. His capacity for development cannot be determined 
from the improvement indices of one trait. Scientific 
pedagogy will make little progress until this fact is recog- 
nized, so that the educational activities may be adjusted 
to meet individual developmental idiosyncrasies. 

Although there are these individual differences the char- 
acter of the central tendencies is unmistakable: there is a 
decided gain in every test, and not only are the gains 
decidedly more frequent than the losses, but the largest 
gains are invariably emphatically larger than the largest 
losses. This may be seen from the following data for each 
test, based on the average scores of tests 1 and 2, and the 
averages of tests 5 and 6 (see also Graphs V to IX). 



Sitting 



Graph V. 

Memorizing Tliree-place Digits. 
Per cent of efficiency. 



I 


7 


n 


4 


, 7 


t t ^ " 


t t 


T ^ 


i ;^ 


aJ- 







12 3 4 5 6 1-23-6 1-6 



Sitting 



Graph VI. 

Spontaneoiis Association. 

Per cent of efficiency. 



11 IV I 



6 1-2 3-6 1-6 



Graph VII. 

Addition of One-place Digits. 
Per cent of efficiency. 






Sitting- 



6 1-2 3-6 1-6 



Sitting 



Graph VIII. 

Antonym Test. 
Per cent of efficiency. 



L 4 



1-2 3-6 1-6 



Graph IX. 

Cancelling A^s. 

Per cent of efBciency. 






Sitting 



6 1-2 3-6 1-6 



Explanation of Graphs. The score for each test is 
shown in per cents along the vertical axis. The successive 
sittings are indicated by the figures under the horizontal 
line at the bottom. 1—2 is the average of 1 and 2, 3-6 of 3 
to 6, and 1-6 of 1 to 6. Sitting 1, May 31, 1910; sitting 
2, June 6 ; 3, August 31 ; 4, September 21 ; 5, May 4, 
1911 ; and 6, May 10, 1911. For other graphs see Dental 
Cosmos, 1912, May, from which these curves are repro- 
duced. 



288 MENTAL HEALTH OF SCHOOL CHILD 

Memory: eight pupils lost in amounts varying from 
5 to 15 per cent, while nineteen gained in amounts varying 
from per cent to 116 per cent. The average gain for 
all pupils amounted to 19 per cent. 

Spontaneous association: two pupils lost, the one 18 and 
the other 43 per cent, while twenty-five gained from 2 to 
162 per cent. The average improvement amounted to 42 
per cent. 

Addition: one pupil suffered a loss of 13 per cent, 
twenty-six gained from 6 to 125 per cent, while the aver- 
age improvement was 35 per cent. 

Associating antonyms : all the pupils gained in amounts 
varying from 33 to 666 per cent, the average gain being 
129 per cent. 

Perception- attention: all gained in amounts varying 
from 19 to 101 per cent, the average improvement amount- 
ing to 60 per cent. 

It is thus evident that the gains varied considerably in 
the different tests, and that the largest improvement 
occurred in the antonym, attention-perception and spon- 
taneous association tests. The average gain for all tests 
amounted to 57 per cent, truly a remarkably large gain. 

How large a percentage of this significant gain is due 
solely to the improved physical condition of the pupils, 
which resulted from the treatment? This question does 
not admit of a categorical answer in the absence of paral- 
lel data from an untreated squad. Because of the brevity 
of the tests, the length of the intervals between the tests 
and the counteracting effect of the growing monotony 
during the successive sittings, it is improbable that the 
practice effects were considerable. The improvement 
from familiarity would probably be larger, but, as a 
matter of fact, many lost instead of gained in the second 



ORAL ORTHOGENICS 289 

test. The factor of novelty (in the first test) apparently 
was stronger than familiarity (in the second test). It is 
certain that children improve very little in their academic 
work from a similar amount of practice. But if we 
concede that one-half of the gain — and that is, I believe, 
a sufficiently liberal concession^ — is due to a number of 
extrinsic factors, such as familiarity, practice and in- 
creased maturity, the gain solely attributable to the 
heightened mentation resulting from the physical improve- 
ment of the pupils would still be very considerable. There 
is corroborative evidence to show that there was a general 
improvement in the mental functioning of these pupils. 
This evidence is supplied by the examination of the peda- 
gogical record of scholarship, attendance and deportment. 
Most of the members of this experimental squad were 
laggards and repeaters, pedagogically retarded in their 
school work from one to four years, but during the experi- 
mental year only one pupil failed of promotion, while six 
did thirty-eight weeks of work in twenty-four weeks and 
one boy finished two years of work within the experimental 
year. Apparently the pupils' physical condition had been 
so bettered that they were able to profit by the instruction, 
to form habits from practice and to improve mentally as 
a result of increasing maturity. They were making 
normal progress during the experimental year, while many 
had failed to do so during the preceding year. During 
the preceding year many of the pupils were quite irregular 
in their attendance owing to toothache, chronic weariness, 
bodily indispositions, irritability or distaste for school 
work, and five pupils were obliged to carry truancy cards ; 
but during the experimental year the attendance was 
materially improved, the cases of truancy entirely dis- 
appeared, while certain boys considered formerly as incor- 



290 MENTAL HEALTH OF SCHOOL CHILD 

rigible now established new records for deportment and 
for tractability. 

The improved physical and mental health of many of 
the pupils, which was noticed by the teachers, commented 
on by the parents and fully realized by the pupils, was also 
made manifest in a more buoyant spirit, a healthier com- 
plexion and an improved disposition and deportment. 

This experiment, then, furnishes the first demonstration 
by means of controlled serial experimental tests, extend- 
ing throughout a calendar year, of the psycho-orthogenic 
effects of the community application of the broad prin- 
ciples of mouth hygiene. The conclusions which follow 
from the results of the research are of far-reaching 
importance to the state and nation (see Chapter XIV). 



CHAPTER XIV 

THE RELATION OF ORAL HYGIENE TO EFFI- 
CIENT MENTATION IN BACKWARD 
CHILDREN^ 

My interest in the Oral Hygiene Movement springs 
largely from my interest in race amelioration and conser- 
vation. There are two fundamental methods by means of 
which we shall be able to conserve the best interests of the 
race: (1) by improved breeding, or eugenical mating. 
This is the more important of the two classes of measures, 
but it is likewise the more difficult to put into practical 
operation. We cannot escape the fact that there is a 
very wide chasm between theoretical and practical eugen- 
ics. (2) By improved bringing up, or the efficient control 
of euthenical factors. Among these factors I include not 
only improved methods of child training and education, 
but also improved hygienic and sanitary nurture and cor- 
rective and remedial care. While the problem is essen- 
tially one of prevention rather than one of cure, we cannot 
blind ourselves to the existence of defects already estab- 

1 Substance of an address delivered before the Academy of Science 
and Art, Pittsburgh, Pa., February 14, 1913 At this meeting a 
moving picture film, 'Toothache,' was shown. This film is being 
exhibited throughout the United States, in the interest of the Oral 
Hygiene Movement which has been inaugurated by the National 
Mouth Hygiene Association. Reprinted from The Child, London, 
1913, pp. 27-32, and from Oral Hygiene, 1913, pp. 892-897, with 
eliminations and additions. 



292 MENTAL HEALTH OF SCHOOL CHILD 

lished, but must make every effort to correct or remove 
these. Now, there is a general conviction that the appli- 
cation of the above two classes of preventive and correct- 
ive measures will improve the biological capital of the race, 
and thus make for race amelioration. Among other things, 
there are those who beheve that by the removal of the 
physical handicaps which afflict our children we shall be 
able to elevate not only their health standard but also 
their mental standard. This is a question in which I have 
taken a genuine interest for a number of years. I have 
been particularly interested in obtaining demonstrated or 
demonstrable facts which would either prove or disprove 
the claim that the removal of physical handicaps will 
increase the mental efficiency of school children; for, fun- 
damentally, in a state of civilization we cannot hope to 
fashion a higher type of humanity without elevating the 
mental index of childhood — although not, to be sure, at the 
expense of the body — for success in a state of civilized 
society depends more on strength of mental action than on 
force of muscular power. 

In looking through the hterature, however, I found 
little direct or incontrovertible evidence that the mentation 
of school children could be elevated by correcting physical 
defects (I am not now speaking of diseases). To this 
general statement there is one conspicuous exception, 
namely, thyroid treatment in the case of cretins or persons 
suffering from thyroid insufficiency. To be sure, there 
were numerous observations— not to say extravagant 
claims — on record of the marvelous improvement made in 
individual instances from proper nose, throat, eye and ear 
treatment, particularly of the improvement resulting from 
the removal of adenoids. But this was not what I wanted. 
Instead of casual observation and opinion, I wanted experi- 



ORAL HYGIENE 293 

mental evidence of a quantitative nature. But there was 
no such evidence available ; no attempt had been made to 
measure by definite controlled objective tests the degree of 
mental improvement resulting from the correction of vari- 
ous kinds of physical handicaps. The nearest approach to 
an exact quantitative investigation were the few statistical 
studies made on the relation between pedagogical retarda- 
tion and physical defects. But these studies suffered from 
serious defects of one kind or another (see Chapter XV). 
The necessity therefore appeared urgent to undertake an 
experimental inquiry, by which to measure by controlled 
objective tests the influence of the removal of physical 
defects on the working capacity of school children. It 
seemed to me that the best point of attack for such an 
investigation was the diseased and unhygienic cavity of the 
mouth, for two reasons : first, because there is no disease 
of childliood wliich is so prevalent as dental caries, in fact 
this defect is so common that it has been appropriately 
called 'the disease of the people' ; second, because, in 
accordance with the statement accredited to Osier, 'There 
is not any one single thing more important in the whole 
range of hygiene than the hygiene of the mouth.' Accord- 
ingly, I suggested to the then chairman of the Oral 
Hygiene Committee of the National Dental Association 
(Dr. W. G. Ebersole) that a series of psychological tests 
be carried out on a squad of school children suffering from 
very bad conditions of the mouth, with a view to arriving 
at a definite, objective, impersonal measurement of the 
orthophrenic effects which might be assumed to follow 
proper dental treatment and mouth sanitation (for the 
description of the experiment and discussion of the results 
made at this point in the address, see Chapter XIII). 



294 MENTAL HEALTH OF SCHOOL CHILD 

The significant positive results of this experiment sug- 
gest considerations of great practical moment. 

There is no phase of the entire modern child conserva- 
tion movement which merits deeper scientific study by 
qualified experts than the relation between the normal 
physical, mental and pedagogical health, growth and 
development of school children than a community plan of 
physical and mental orthogenesis. No phase of the prob- 
lem of national conservation or racial euthenics more 
nearly affects the very fundamentals of human existence. 
Our greatest national asset is the normal, healthy child — 
the child originally sound in body and mind by virtue of a 
rich hereditary dower, or the child rendered sound by the 
removal of physical or mental handicaps through the 
appHcation of the broad principles of human physical and 
mental orthogenesis. Instead of devoting their resources 
to the gathering of mere statistics, to making surveys of 
what tliis community and that city are doing to better the 
welfare of the child, or to treating results rather than 
causes, our child conservationists, eugenic enthusiasts and 
welfare foundations could make a larger contribution 
toward the permanent betterment of the race by under- 
taking on an adequate scale genuine scientific investiga- 
tions of the physiological, psychological, hereditary and 
sociological causes of bodily and mental disability and 
inefficiency, and of the demonstrable effects of the broad 
application of orthophrenic and orthosomatic measures. 
The largest contribution to the permanent betterment of 
the race will be made by those workers who will undertake, 
on an adequate scale, genuine, scientific investigations into 
the actual, demonstrated effects of the application of 
various orthogenic measures of a physical and mental 
character. No such investigations are anywhere being 



ORAL HYGIENE 295 

prosecuted on an effective basis, notwithstanding that no 
one knows the actual, proven effects on the child of the 
appHcation of various physical and psychological ortho- 
genic measures or various pedagogical methods and 
devices. Our knowledge in this field is largely pretense 
and illusion. In no field of organized modern enterprise 
has there been such a lame attempt made to measure 
results scientifically as in education. Indeed, we do not 
as yet so much as possess any strictly reliable scientific 
measures of educational results : the very conception of 
'measuring results in education' is a product of very recent 
industrial thinking. Is it not time that our large research 
foundations begin to treat more fairly the problems of 
human conservation and particularly those of child ortho- 
genics? A million dollars spent in orthogenic investiga- 
tions — in the discovery of the psychological, dento- 
medical, social, hereditary, pedagogical and anthropo- 
metric factors of deviate development in children and in 
the ascertainment of corrective measures — will accom- 
plish immeasurably more for the welfare of the human 
race than tens of millions devoted to the cataloguing of 
the stars of the heavens or exploring the trackless wastes 
of the polar regions. 

The results at which we have arrived in this experiment 
by controlled objective quantitative methods emphasize 
anew the paramount importance of teaching the pupils in 
our schools proper dental prophylaxis, and of establishing 
dental clinics and dispensaries, and supplying free dental 
treatment in the schools to all certified indigent cases. 
But it should be specially emphasized that, owing to the 
enormous number of children suffering from diseased teeth, 
it is not sufficient merely to establish school dental clinics. 
There are not enough dentists in any community to treat 



296 MENTAL HEALTH OF SCHOOL CHILD 

the teeth of all the children who have oral defects. It is, 
therefore, imperatively necessary that the work of dental 
hygiene be so organized on a community basis that chil- 
dren may be systematically taught to care for their teeth 
and sanitate their rnouths from the day that, as members 
of the schools, they become wards of the state or of the 
community. 

Among the fruits wliich would accrue from the introduc- 
tion of mouth hygiene instruction and the establishment of 
dental clinics in the schools may be mentioned the follow- 
ing: (1) Value to the afflicted pupils themselves. Dental 
hygiene furnishes a means of ridding the suffering pupil 
from the exciting cause of pain, disease, mental stagnation, 
moral deviation and irregular school attendance. It is 
one of the effective means available for raising the child's 
actual efficiency a httle nearer to its maximal potential. 
Dental hygiene is a godsend to the individual child. The 
free dental school clinic must appeal to all lovers of chil- 
dren on humanitarian grounds. (2) Benefits to the school 
system. Dental hygiene is one of a number of effective 
means of combating the evils of pedagogical retardation, 
repetition, elimination, non-attendance and delinquency. 
It is a practical means of increasing the efficiency of the 
school system. It should appeal to the teacher, school 
administrator and school efficiency engineer. (3) Finan- 
cial value to the taxpayers. The greater the return on the 
investment, the cheaper will be the cost of maintaining the 
schools ; and obviously, the more proficient the pupils are 
made, the greater will be the returns on the investment. 
The provision of free dental inspection and treatment for 
indigent pupils is an economic measure of the first magni- 
tude. In terms of dollars and cents, the annual saving in 
any school system would amount to a very considerable 



ORAL HYGIENE 297 

sum. For example, let us assume that those pupils who 
suffer from the very worst mouth conditions would improve 
only 15 per cent in working efficiency as a result of the 
application of a judicious system of mouth hygiene. This 
is a very conservative estimate ; the improvement would 
probably be nearer 25 per cent. Now let us assume that 
at least 20 per cent of the 65,000 pupils enrolled in the 
elementary public schools of Pittsburgh suffer from very 
bad oral conditions, and that these pupils are in such 
impoverished circumstances financially that they would 
not obtain any dental treatment unless school clinics were 
established. The approximate cost of instruction for the 
elementary pupils in the public schools of Pittsburgh 
amounts to $30 per year, therefore if each of these 13,000 
pupils gained 15 per cent in working efficiency as a result 
of dental treatment there would accrue a saving of $4.50 
per year for each one of these pupils, or $58,500 a year 
for these 13,000 cases. This estimate, however, probably 
fails to do full justice to the benefits to be derived, because 
it is an undoubted fact that a very large number of this 
group of children who suffer from very bad dental condi- 
tions would fail in their school work, and thus have to be 
educated at least twice in the same grade. That would 
mean an additional cost of $30 per year for every repeater. 
Dental treatment would save very many of these cases 
from failure to make their grade, and thus save the cost 
of repetition to the taxpayer. According to the best 
estimates, it costs the country $27,000,000 annually to 
educate every sixth child two or three times in the same 
grade. That part of this enormous waste which is ascrib- 
able to the presence of those remediable physical defects in 
the children which exert a retarding influence upon the 
mental processes or which cause children to stay away from 



298 MENTAL HEALTH OF SCHOOL CHILD 

school is entirely preventable. (4) Benefits accruing to 
race conservation. Dental hygiene will improve the mental 
and physical health of the individual child, and this, in time, 
will lay the basis not only for a more efficient citizenship 
but also for a more efficient parenthood; for by elevating 
the health index of children we shall not only increase the 
health, happiness and productive capacity of adults but 
also elevate the genesic or reproductive index of the race. 
The application of the best euthenical principles of race 
amelioration will probably also produce the highest eugeni- 
cal results. This argument is perhaps one of the strongest 
arguments for developing community plans of child ortho- 
genesis. Our most sacred duty is to the race, to posterity. 
Most of what we have we owe to our ancestry, and the best 
that we possess we should strive to bequeath to our pos- 
terity ; and the most precious gift which we can bestow 
upon posterity is a normal, healthy progeny and an 
uncontaminated heredity. 

Is it worth while to attempt to save the enormous 
annual waste in the schools due to the defective mouths of 
the pupils ? Is it worth while to the taxpayer to eliminate, 
so far as possible, the necessity for the extra financial 
burden which he must assume for instruction that should 
have been done satisfactorily the first time? Is it worth 
anything to the child to enable him to attend school more 
regularly and thereby increase his chances of promotion? 
Is it worth while to the repeater to shorten his stay in the 
schools ? Is it worth while to enable him to attain a higher 
level of academic efficiency? Is it worth while to remove 
physical obstacles which may lessen his efficiency for life? 
There can be none but an affirmative answer. One of the 
means for accomplishing these desirable results appears 
to be the establishment of departments of orthogenics in 



ORAL HYGIENE 299 

the public schools. But these departments must be given 
a broader scope than are the present departments of medi- 
cal inspection, and must be under the skilled direction of 
health officers who are experts in educational, child and 
clinical psychology, corrective pedagogy and preventive 
and corrective hygiene. One division of these departments, 
'orthosomatics,' should include dental dispensaries. 



CHAPTER XV 

METHODS OF MEASURING THE ORTHO- 
PHRENIC EFFECTS OF THE REMOVAL 
OF PHYSICAL HANDICAPS' 

The conviction that there is an intimate relationship 
between physical defectiveness and mental inefficiency or 
irresponsibility has become an accepted postulate of cur- 
rent educational, psychological, medical and criminolog- 
ical thought. But for the most part, this belief has been 
based on mere opinion, or favorable chance observations. 
It is only within recent times that any attempt has been 
made accurately or scientifically to evaluate the physical 
or mental influences of physical defects. And yet, our 
whole system of pupil inspection, whether medical, dental 
or psychological, must ultimately justify itself to the 
taxpayer by its demonstrated orthogenic results. The 
taxpayers have a right to know whether their systems of 
school medical, dental and psycho-educational inspection, 
clinics and dispensaries represent a paying investment. 
In a matter which assumedly so vitally concerns the con- 
servation of our racial vigor, we cannot aff^ord to rest our 
case upon the verdict of assumption, opinion, uncritical 
thought, a priori argument or on the unaided and favor- 
able chance observations of physicians and teachers. 

1 An address delivered at the third annual conference of the Na- 
tional Association for the Study and Education of Exceptional 
Children, New York, November, 1912. 



PHYSICAL HANDICAPS 301 

Either physical defects do or they do not have a deter- 
minate retarding, deflecting or disharmonizing effect upon 
the physical and mental health, growth and development 
of the average child. If they do, this fact must be amen- 
able to demonstration by the methods of modern science. 
The scientist rightly insists that the fields of physical and 
mental orthogenesis (orthosomatics and orthophrenics) 
must be subjected to exactly the same kind of investigation 
by verifiable, demonstrable, objective measures and the 
same critical scrutiny as any other field of modern inquiry. 

In the present paper I shall attempt a brief survey of 
the six methods which have been employed to measure 
quantitatively the influence of physical defects on mental 
or pedagogical efficiency, and shall also very briefly 
resume and evaluate the findings with each method. 

1. Computations have been made of the comparative 
per cent of pedagogical proficiency, in terms of average 
scholarship rating, attained by groups of physically 
defective and physically normal children. The compari- 
son is based on the assumption that if physical defects 
exert a retarding influence the physically defective groups 
should rank lower in scholarship. 

Of 219 boys and girls ranging from six to twelve years 
of age examined in one school in Philadelphia in 1908, it 
was found that the average grade attained was 75 
per cent for 'normal children,' 74 per cent for 'average 
children,' 72.6 per cent for 'general defectives," and 72 
per cent for pupils who had adenoids and enlarged tonsils 
(Cornell, Psychological Clinic, January, 1908). While 
the difference between the extreme groups amounts to only 
3 per cent, the physically normal pupils, at any rate, 
rank slightly higher in scholarship than groups of physical 
defectives. 



302 MENTAL HEALTH OF SCHOOL CHILD 

This method is subject to the criticism that it deals to 
some extent with an abstraction. The strictly physically 
normal child is largely a myth. This method, therefore, 
only enables us to compare the scholarship of children 
relatively free from physical defects with children quite 
obviously handicapped. 

2. Enumerations have been made of the average num- 
ber of physically defective pupils found in groups of 
pedagogically or mentally defective, retarded, normal and 
supernormal pupils. Here, again (because the method is 
just the obverse of the preceding), the argument is simi- 
lar : if physical defects reduce the child's working efficiency 
or impair his mentality we should find more physical 
defects among the feeble-minded, backward and dull, than 
among the on-time, or the bright pupils. A number of 
investigations have approached the question from this 
point of view. 

In Halle, it was found that only 26 per cent (or fifty- 
seven cases) of the 215 pupils (assumedly feeble-minded) 
enrolled in the auxihary classes in 1901 were free from 
physical defects (exclusive of trivial disorders), while in 
1903-1904 only 12 per cent of the 209 enrolled were in 
'perfect condition.' Unfortunately no comparative data 
for pedagogically normal children are given. 

A study of 137 entrants in the schools of Princeton, 111., 
in 1901-1902 showed that those retarded only one year 
had no physical defects, while all of those retarded three 
years or more were defective (Gayler). 

In Jefferson City, Mo., 37 per cent of the pupils inves- 
tigated who had defective eyes did unsatisfactory work, 
while only 26 per cent of those who had good eyes did 
unsatisfactory work. 

In Los Angeles, only 16 per cent of fifty markedly 



PHYSICAL HANDICAPS 303 

bright pupils were found physically defective, as against 
86 per cent of fifty dull pupils. 

In the schools of Camden, N. J., 8,110 on-time and 
2,020 retarded pupils were given a physical examination 
in 1906. The percentages of defective vision and hearing 
were for the on-time (or normal-age) pupils 27.1 per cent 
and 3.7 per cent, respectively, while the corresponding 
figures for the retarded group amounted to 28.9 per cent 
and 5.8 per cent, a difference of merely 1.8 per cent and 
2.1 per cent respectively. A special inquiry into the 
causal factors of the failure of the 2,020 retardates also 
indicated that physical defects were of minor importance. 
The causes were ranked as follows: late entrance, 21.2 
per cent ; slowness, 21- per cent ; absence, 28.5 per cent ; 
dullness, 12 per cent ; ill health, 9.6 per cent ; defects other 
than visual and auditory, 3.9 per cent, and mental weak- 
ness, 3.7 per cent (Bryan). A reexamination of 1,279 
on-time and 573 retarded pupils, who failed of promotion, 
gave the following results : 

On-time Retarded Difference 

Per cent Per cent Per cent 

Defective vision 51 40 — 11 

Defective hearing 14 11 — 3 

Bad health 21 21 

Irregular attendance 30 40 10 

Curiously, the normal-progress pupils were more defective 
than the retardates. 

But among 203 Cleveland, Oliio, school children which 
were investigated, it was found that only 63 per cent with 
a scholarship mark of 'very good' had physical defects, as 
against 73.1 per cent of those marked 'good,' 71.1 per cent 
of those marked 'fair' and 86.6 per cent of those marked 
'poor.' 



304 MENTAL HEALTH OF SCHOOL CHILD 

In Philadelphia, physical examinations have been made 
of so-called 'exempt' and 'non-exempt' pupils. Exempt 
pupils include those who are advanced to a higher grade 
without examination, by virtue of superior attainments. 
Of 907 exempt pupils examined in five schools only 28.8 
per cent were defective, as against 38.1 of 687 non-exempt 
(Cornell). In another group consisting of 3,587 exempt 
and 1,418 non-exempt pupils, only 49 per cent of the 
exempt were defective, as against 65 per cent of the 
non-exempt. The differences amounted to per cent for 
defective vision, 2 per cent for defective hearing, .6 per 
cent for nose defects, — .1 per cent for throat defects, 
1.1 per cent for orthopedic defects, 5.5 per cent for mental 
defects, 4 per cent for skin diseases and 3 per cent for 
miscellaneous defects (Newmayer). Singularly, the dif- 
ference is considerable for certain defects which should 
have little bearing on mental efficiency, while it is negli- 
gible for those defects which are considered to impair 
mental action. 

Another investigation in Philadelphia showed that in the 
general school population the percentage of physically 
normal pupils was 38 per cent, while in a primary 
school for dull pupils (William McKinley) it was only 
half as large, or 19 per cent, and in classes for the high- 
grade or feeble-minded it was still less, or 12 per cent. 
This study no doubt also includes defects which can have 
little bearing on mentality ; but it is significant that there 
were only 28 per cent of eye defects in the general school 
population, as against 80 per cent, 39.4 per cent and 42 
per cent, respectively, in two schools for retardates and 
in the classes for the feeble-minded. Again, in one school 
the percentages of nose and throat defects in two bright 
classes were 12 per cent and 10.2 per cent, respectively, 



PHYSICAL HANDICAPS 305 

while in two of the dullest sixth and seventh grades the 
figures were 28.1 per cent and 31 per cent, respectively 
(Coraell). 

On the other hand, if we turn to an investigation made 
in New York City embracing 7,608 pupils in the eight 
elementary grades, 6,084 of whom were on-time and 1,524 
retarded, we find, curiously, that the percentage of physi- 
cal handicaps was actually 4.9 per cent greater for the on- 
time than for the retarded group (79.8 per cent vs. 74.9 
per cent: Ayres). Another investigation of 3,304 New 
York pupils ranging from ten to fourteen years of age 
seems to explain the curious discrepancies found in 
New York City and Camden. It indicated that compari- 
sons in respect to physical defectiveness between over-age 
retarded and on-time normal children may be quite worth- 
less, because of discrepancy in the age of the pupils. It 
was found that a marked decrease in the prevalence of 
some defects begins at eight, nine and ten, and that if the 
younger children are excluded from the study, a positive 
correlation exists between physical defects and the peda- 
gogical rating. This may be seen from the following 
per cents of various defects among bright, normal and 
dull pupils : 

Defect Bright Normal Dull 

Enlarged glands 6 13 20 

Defective vision 29 25 24 

Defective breathing 9 11 15 

Defective teeth 34 40 42 

Hypertrophied tonsils 12 19 26 

Adenoids 6 10 15 

Other defects 11 11 21 

Per cent defective 68 73 75 



306 MENTAL HEALTH OF SCHOOL CHILD 

It is noteworthy that the largest differences are for defect- 
ive teeth, defective breathing, adenoids and enlarged 
tonsils. 

In Elmira, N. Y., an investigation of repeaters in the 
second grade showed that 21 per cent of those who 
required three years, and 40 per cent of those who required 
four years to complete the grade had adenoids, as against 
only 19 per cent of those who required only two years to 
do the grade. Seventeen per cent and 27 per cent, respect- 
ively, of those who spent three and four years in the grade 
suffered from anemia, as against 15 per cent for those 
who required two years. The corresponding figures for 
defective vision are 24 per cent and 26 per cent, as 
against 21 per cent. Here there is a consistent positive 
correlation. 

In 1907, a special study was made of 1,000 of the Cam- 
den repeaters (Heilman). The pupils were divided into 
five groups according as they were retarded from one to 
five years, and the percentage of pupils in each group 
having physical defects was computed. The correlation 
between pedagogical retardation and the percentage of 
physically defective cliildren is given for the various 
defects in the following tabulation: 



1 year 

Defects Per cent 

Health 16.5 

Nutrition 13.4 

Adenoids 6.2 

Speech 5.2 

Visual defects .... 15.5 

Auditory defects . . 8.2 



Retardation 






2 years 


3 years 


4 years 


5 years 


Per cent 


Per cent 


Per cent 


Per cent 


21.3 


28.0 


19.0 


37.5 


8.9 


17.2 


20.2 


17.5 


7.3 


8.1 


9.6 


7.5 


5.1 


4.2 


10.5 


20.0 


15.9 


18.2 


22.8 


22.8 


6.7 


4.9 


6.1 


10.0 



PHYSICAL HANDICAPS 307 

Here there is a fairly good, although not uniformly 
consistent, positive correlation. 

In spite of the discrepancies which we have found in the 
review of this method, the results, in the main, point to a 
positive correlation between physical defectiveness and 
pedagogical retardation. But the method itself, however 
valuable, is subject to various shortcomings. As usually 
applied, no cognizance is taken of differences of age, social 
and economic status, differences in the environment and 
other factors which are believed to influence both retarda- 
tion (and acceleration )and physical defectiveness. For 
example, as already indicated, certain physical defects 
increase with age (viz., the visual, spinal and nervous), 
while others decrease (viz., the nasopharyngeal, auditory 
and dental). It is therefore evident that without a rigid 
control of conditions the results may be entirely mislead- 
ing. Moreover, both the physical defects and the mental 
torpor may be merely symptoms of an underlying factor 
which is their common cause. They may not be inde- 
pendent variables, or even variables dependent upon each 
other, but both may be dependent upon a third factor or 
set of factors. 

3. The average number of physical defects per child 
has been ascertained for groups of pedagogically re- 
tarded, on-time and accelerated pupils. This method 
differs from the preceding only in that instead of finding 
the per cent of defective pupils in the different peda- 
gogical groups the average number of defects per child is 
found. It is, again, assumed that if there is any causal 
relation between physical defects and pedagogical stagna- 
tion, the more numerous the defects the greater will be the 
retardation in any given case. 

Investigations made in Chicago from 1903 to 1905 



308 MENTAL HEALTH OF SCHOOL CHILD 

showed that 1,600 boys in the regular grades had an 
average each of 4.6 to 5.3 of growth defects (these 
'growth' are not synonymous with the so-called physical 
defects), while the corresponding number of 'motor' 
defects ranged from 2.9 to 4.3 per child. But in the 
parental school, in which most of the boys were peda- 
gogically retarded from one to five years, the number of 
growth defects averaged from 6.8 to 7.3, and the number 
of motor defects from 5.2 to 6.1. The deficiency for the 
parental school boys averaged about 25 per cent higher 
than for boys hailing from the better sections of the city. 
Not only were the defects among the disciplinary cases 
more numerous but they were more pronounced in severity 
(Bruner, 1906). 

In the New York investigation, based on 3,304 cases, 
to which reference has already been made, the average 
number of defects for bright children was 1.07; for 
normal children, 1.30; and for dull children, 1.65, an 
appreciable difference as between the bright and dull. 

The average number of physical defects per child for 
the 1,000 Camden repeaters, already mentioned, was as 
follows for the groups retarded one, two, three, four and 
five (or more) years: .65, .65, .82, .89 and 1.20 (Heil- 
man). Here there is a fairly consistent increase in the 
number of defects with each increasing year of retardation. 
This method possesses the same virtues and the same 
defects as the preceding method. The results may be 
vitiated by the inclusion in the averages of physical defects 
which have no relation to intelligence, although they may 
multiply with increasing retardation, and by the fact that 
the physical defects may be no more truly causative of the 
mental deficiency than the mental deficiency is causative 



PHYSICAL HANDICAPS 309 

of the physical defects, because both may be only symptoms 
of an underlying lack of biological capital. 

4. Pupils may be classified on the basis of psycho- 
logical tests of certain mental traits, into subnormal, 
normal and supernormal groups, and after being so classi- 
fied the average number of physical defects per child, or 
the percentage of physically defective children in each 
group, may be ascertained. This method has elements in 
common with all the preceding methods, but the difference 
is that the pupil's mental status is determined by objective, 
controlled psychological tests rather than by the mere 
judgment of the teacher or by the less accurate pedagogi- 
cal tests. Here the attempt may be made not only to 
determine the inherent strength of various mental traits, 
such as memory, imitation, perception, association, atten- 
tion or reasoning, but also the relation of specific mental 
defects to specific physical defects. 

No satisfactory studies of this type have been made. 
Two studies from the Chicago public schools may, however, 
be referred to in tliis connection. In 1900-1901 a study 
was made of the relation between deficiency in visual and 
auditory memory and subnormal visual and auditory 
acuity. A slight positive correlation was found. Of those 
who were superior to the average in auditory memory, 32 
per cent had visual and 10 per cent had auditory defects; 
while the corresponding per cents for those who were 
inferior to the average were 41 per cent and 14 per cent. 
Of those superior to the average in visual memory, 32 per 
cent had visual and 10 per cent hearing defects ; while for 
those inferior in visual memory the figures were 45 per 
cent and 15 per cent (Smedley). 

In 1904-1905 a study was made of 256 delinquent boys 
in the parental school. The teachers made a careful study 



310 MENTAL HEALTH OF SCHOOL CHILD 

of the memory, reasoning and attention capacities of the 
pupils (but presumably not by controlled tests), and 
special investigators examined the boys for defects in 
growth, particularly for cranial anomalies. A corre- 
spondence between the physical and mental conditions was 
found in 77.5 per cent of the cases, and no correspondence 
in 22.5 per cent. The 'bright' pupils had less defects than 
the normal, the *fair' about the average number, and the 
'poor' were decidedly below par. 

It is regrettable that so little use has been made of this 
method, for there can be no doubt that valuable data for 
the scientific solution of our problem may be obtained by 
the application of mental tests, provided proper care be 
taken in the selection and control of the tests and in the 
selection of the control subjects. 

5. The rate of progress through the elementary 
grades has been ascertained for groups of pupils suffering 
from various physical defects and for groups free from 
physical defects. How much longer does it take physi- 
cally defective pupils to complete the eight elementary 
grades than physically normal pupils .? What is the dif- 
ference in the retarding influence of various kinds of 
physical defects ? How long will it take the adenoid child 
to finish the eight grades.? How long the child with 
enlarged tonsils, with teeth defects, etc. ? It is contended 
that if physical defects exert a retarding influence on 
pedagogical efficiency the progress must be slower for 
physical defectives than for normal pupils. 

Only one study of this sort has been made, namely the 
New York study of the 3,304 children whose ages ranged 
from ten to fourteen. The percentages of loss of peda- 
gogical efficiency was determined for groups of these chil- 
dren suffering from different kinds of physical defects. 



PHYSICAL HANDICAPS 311 

The loss in time, based on the average number of years 
completed (4.94) by the pupils who had no physical handi- 
caps, was as follows : for defective vision, per cent ; for 
seriously defective teeth, 5.9 per cent ; for defective breath- 
ing, 7.2 per cent ; for enlarged tonsils, 8.9 per cent ; for 
adenoids, 14.1 per cent; for enlarged glands, 14.9 per 
cent, and for other defects, 8.5 per cent. On the average, 
the retarding influence of the physical handicaps appeared 
to amount to 8.8 per cent (Ayres). 

This method marks some advance upon previous 
methods, but its crudity is apparent. It insures little, if 
any, control of conditions. It makes no attempt to isolate 
individual defects, except in a crude fashion. It is obvious 
that various defects may coexist in the same child, and 
that a variety of complications may exist. The method 
fails to evaluate the relative influence of the contributing 
factors, whether these be physical, sociological, environ- 
mental or mental. The physically 'normal' children used 
as standards were probably only relatively free from 
defects. Moreover, if anyone should use eight years as 
the standard time required by the normal child to complete 
the elementary course he would be using a purely theoreti- 
cal criterion. There are no direct data available to show 
that the average child, or even the child free from physical 
defects, is able to finish the eight elementary grades in 
eight years. In fact, the data we have indicate that the 
average child requires 9.34 years to finish the eight grades, 
for in an investigation of promotion in grades one to five 
in twenty-nine American cities it appeared that in no city 
did the average child finish the four years on time. The 
shortest was 4.08 years, the longest 6.22, while the average 
was 4.67. For every rapid-progress pupil there were 
found from eight to ten slow-progress pupils (Ayres). 



312 MENTAL HEALTH OF SCHOOL CHILD 

It is therefore apparent that the only legitimate basis of 
comparison is the number of years actually required to 
finish the elementary course either by the average pupil or 
by the pupil relatively free from defects, and not the 
theoretical eight years. 

6. Finally, a sixth method approaches the problem 
from an entirely different point of view, namely from the 
orthogenetic standpoint. It consists in correcting the 
child's physical handicaps by proper orthosomatic treat- 
ment, and then ascertaining whether or not there is any 
improvement in scholarship, mental vigor, working capa- 
city, classroom attendance, promotion or deportment. If 
we wish to determine whether adenoids interfere with 
mental development, let us remove them and find out what 
happens. 

Of studies of this kind there are innumerable sporadic 
observations, and one psycho-experimental investigation. 

In Philadelphia, seventy more or less retarded pupils in 
grades one to four were operated for adenoids. The 
reports of the teachers, based on sixty-three cases, indi- 
cated that 30 per cent 'improved considerably,' 40 per 
cent 'improved,' 25 per cent did not improve, 1.6 per cent 
deteriorated and 3 per cent deteriorated considerably. 
Of those who had two chances for promotion, 6.3 per cent 
were promoted twice, 16 per cent failed twice, while 33.3 
per cent were promoted once and a like number failed once. 
On the other hand, of those with one opportunity for 
promotion, 11 per cent were promoted, while 31.7 per cent 
failed (Cornell). The promotion record was thus decid- 
edly poor. It is possible, however, that the time for 
promotion came before the orthogenic effects of the 
operations had become effective. 

In New York City, of eighty-seven cases operated for 



PHYSICAL HANDICAPS 313 

enlarged tonsils and adenoids, we are told that 'many' 
(that exasperatingly vague term!) advanced three grades 
during the rest of the school year, and that only three lost 
time (Cronin). 

In the same city, thirty-five pupils who were serious 
retardates in the regular or ungraded classes were fitted 
with glasses in January, 1912, to overcome hyper- 
metropia and myopia. The teachers were asked to make 
estimates of the pupils' work and conduct at this time, and 
again in June, 1912. The record of promotions showed 
that nineteen of the twenty-five pupils in the regular 
grades were promoted, one of the ten ungraded pupils was 
promoted to a regular grade, while seven made very slow 
progress and two made no progress. All were reported 
to have improved in habits, disposition and conduct. 

A random examination in Cleveland, in 1910-1911, of 
the records of 224 corrected cases indicated that 24 per 
cent had improved decidedly in scholarsliip, 21.4 per cent 
had improved in deportment and 33 per cent in attendance. 

In contrast with the above observational, deportment 
or promotion methods of estimating the orthophrenic 
effects of the correction of physical defects, is an experi- 
mental investigation by laboratory methods under con- 
trolled conditions undertaken to discover whether or not 
the mental efficiency of a group of children could actually 
be elevated by proper orthosomatic mouth treatment. 
The description of this experiment and the discussion of 
the results have been given in Chapters XIII and XIV 
and are therefore omitted here. 

This brief review of the present status of the problem 
thus indicates that before long we may look forward to 
the creation of a genuine science of orthophrenics, so that 
we shall be able to say with greater accuracy than before 



314 MENTAL HEALTH OF SCHOOL CHILD 

what kinds of physical obstructions cause the greatest 
amount of retardation, what degree of defect is necessary 
to cause mental impairment, what mental functions are 
most affected by various disabilities, to what extent 
orthosomatic treatment will entirely remove the mental 
damage caused by various defects, and to what extent 
reliance must also be placed on differential orthophrenic 
or corrective pedagogic treatment. The problem is 
extremely complex, and its effective solution demands the 
cooperative efforts of the expert psycho-educational 
examiner, physician and teacher. Moreover, investiga- 
tions should be made from purely disinterested scientific 
motives by private and public research foundations of the 
orthogenic effects of various orthosomatic and ortho- 
phrenic measures. These investigations should cover the 
various psychological, pedagogical, sociological, dento- 
medical, anthropometric and hereditary aspects of the 
problem, (One writer has already made an attempt to 
partially carry out this suggestion.^) 

2 KoHNKY. Preliminary Study of the Effect of Dental Treatment 
upon the Physical and Mental Efficiency of School Children. Journal 
of Educational Psychology, 1913, 4:571ff. 



CHAPTER XVI 

MEDICAL AND DENTAL INSPECTION IN THE 
CLEVELAND SCHOOLS' 

I. The Development of Medical School Inspection 

In 1906, the Board of Health of Cleveland appointed 
twenty-six ward physicians, a part of whose duties con- 
sisted in inspecting, every other day, the public and paro- 
chial schools of their districts for the detection and 
exclusion from the schools of pupils suffering from con- 
tagious and communicable diseases. But excluding chil- 
dren, in conformity with the law, with such communicable 
diseases as pediculosis, scabies, impetigo, etc., created 
serious school problems. Many children thus excluded 
remained out of school for days ; they received no correct- 
ive treatment at home, hence when they returned they were 
often in a worse condition than when they left ; their exclu- 
sion seriously handicapped the regular work of the class- 
room, for these pupils frequently stood in greatest need 
of the classroom processes, and they had to be excluded in 
large numbers owing to the enormous prevalence of some 
form or other of communicable disease. In a number of 
the congested foreign districts of the city, conditions were 
such that not only would exclusion result in a breakdown 
of the school system from the point of view of school 

1 Reprinted, with alterations, from The Psychological Clinic, 1910, 
pp. 93-108. 



316 MENTAL HEALTH OF SCHOOL CHILD 

attendance, but a large percentage of children were forced 
to labor under the handicap of needless suffering, owing to 
the ignorance, indifference or poverty of the parents. 

To checkmate the evils due to those conditions and to 
demonstrate to the Board of Education the importance of 
a system of medical inspection that should embrace exami- 
nation for physical defects, certain inspectors, working 
through the Sanitation Committee of the Chamber of Com- 
merce, volunteered their services without compensation if 
the Board of Education would provide inspection stations 
in those schools in which the need was the most pressing. 
The Board established five of these stations in schools which 
drained large foreign populations, each station in charge 
of a graduate nurse of the Visiting Nurses' Association. 
The first was organized at the Murray Hill School in 1908. 
School dispensaries or clinics, among the first of the sort 
in the country, were connected with two of these stations 
(Murray Hill and Marion). Three others were subse- 
quently added. The equipment of these clinics, provided 
at the expense of the School Board, varies, but consists 
mainly of diagnostic appliances for examining the ear, 
nose and throat, eye test cards, instruments for removing 
adenoids and tonsils and for performing the simpler opera- 
tions, ointments, solutions for treating communicable 
diseases, an instrument case, a metal stand for basins, glass 
top table, couch, enameled chairs, etc. While the primary 
aim has not been to supply free treatment at the clinic, 
emergency cases receive prompt attention, and at one of 
the schools, the Murray Hill (and in a measure, at a couple 
of the others also), all cases of infection, of wax and sup- 
purating ears, atrophic rhinitis and all marked cases of 
adenoids and hypertrophied tonsils have received remedial 
or operative treatment. 



MEDICAL AND DENTAL INSPECTION 317 

The inspection work has been rendered practically 
effective through the 'follow-up' work and the diversified 
ministration of the school nurse. She makes a record of 
the examination, and sends a copy to the child's parents. 
She visits the home to ascertain whether the physician's 
advice has been followed. If it has not, recourse is had to 
the gentle art of suasion, or in extreme cases of neglect the 
juvenile court is invoked. Indigent parents are advised to 
take the child to a free dispensary or hospital clinic. She 
looks after many of the minor troubles while the child 
remains in school, attends to ordinary dressings and the 
child's hygiene in general, inspects the rooms daily and 
treats at the dispensary the simpler infections of the skin 
and head, while referring the more complicated cases to 
the medical inspector. After treatment she follows the 
child home and instructs the mother how to continue treat- 
ment, or, in case the mother is employed, takes personal 
charge. She also teaches the older girls in school how to 
apply bandages and antiseptics, how to prepare common 
disinfectants and antidotes, and explains the importance of 
sanitation and personal cleanliness. She gives baths to the 
girls where showers are provided. Hers is a diversified 
calling, filled with noble achievement. In one month in 
the Murray Hill School, nurses' aid was given to 680 cases, 
while 75 homes were visited. A monthly report of nurses' 
aid in the Harmon School included 195 baths, 215 treat- 
ments for impetigo, 50 for pediculosis, 50 ocular cases 
were referred to the Humane Society and one to the Blind 
Institute. Similar cases from another school in a con- 
gested section (Eagle) are frequently referred to dental, 
medical and babies' dispensaries, and family physicians. 
In 1907, through the cooperation of nurses, physicians, 
teachers, principals, parents, dispensaries, free hospital 



318 MENTAL HEALTH OF SCHOOL CHILD 

clinics and philanthropic organizations, over 3,300 pupils 
received aid of the following nature : 

Number Per cent 

Glasses secured by 990 29.2 

Other eye treatment 1,016 30. 

Ear treatment 228 6.7 

Nasal treatment 379 11.1 

Dental treatment 664 19.6 

Unclassified Ill 3.4 

Total 3,388 100. 

To the thousands of children and parents who have 
profited from this humanitarian and philanthropic minis- 
tration, the school nurse has become a guardian angel. 
There has been no frenzied outcry in Cleveland against this 
physical welfare work either on the part of ignorant or 
superstitious parents, or studied opponents of 'communism' 
or 'socialism.' Objections, so far as they have been heard 
at aU, have been directed by parents against operations or 
by physicians against free treatment. Some parents 
object to the removal of tonsils, through the fear that this 
will injure the voice; and others to the wearing of glasses, 
because they fear that once worn they can never be 
discarded. 

What a boon this work has been to the schools ! Instead 
of ruthlessly excluding infected children from the schools 
and thereby clogging the school machinery, the district 
physician has been superseded by the school medical 
inspector and the school nurse, and the child has been 
permitted to remain in school without the danger of 
infecting his fellows. The statistics from one of the medi- 
cal stations (Marion School) show most impressively how 



MEDICAL AND DENTAL INSPECTION 319 

irregular attendance can be effectually counteracted. It 
has been computed by the principal that the school nurse 
and dispensary between January 1 and June 1, 1909, 
saved 1871 days for the child and the school. Without 
these adjuncts of the school, the following cases of 
exclusion would have been necessary : 

43 infections for 5 days, or 215 days. 

118 cases of conjunctivitis for 5 days 590 days. 

23 cases of scabies for 5 days 115 days. 

25 cases of ringworm for 10 days 250 days. 

57 cases of pediculosis of head for 3 days. 171 days. 

6 cases of pediculosis of skin for 10 days 60 days. 

94 cases of impetigo for 5 days 470 days. 

Total 1,871 days. 

With a rigidly enforced exclusion law these children, and 
others who might have been infected by them, would have 
been deprived of the processes of the schools for about ten 
years in the aggregate, at a tremendous economic loss to 
the taxpayer. This enormous waste was obviated at a 
merely nominal cost to the community. This saving takes 
no account of the increased working efficiency which 
resulted from properly caring for the following 283 non- 
communicable ailments during the corresponding period: 

79 cases of minor injuries. 

65 cases of throat affections. 

40 cases of burns. 

20 cases of chapped hands. 

19 cases of ear affections. 

12 cases of nasal affections. 

10 cases of foreign bodies in eyes. 

10 cases of removed tonsils. 



320 MENTAL HEALTH OF SCHOOL CHILD 

10 cases of eczema. 

9 cases of adenoids. 

7 cases of canker sores. 

2 cases of cold sores. 

To render this auxiliary work of the schools still more 
effectual, volunteer work in the direction of feeding indi- 
gent, anemic and underfed children has been started in 
some of the schools. The Philanthropic Committee of the 
Cleveland Federation of Women's Clubs regularly serves 
a simple breakfast in the Eagle School to an average of 
thirty-six pupils per day. 

As a result of tliis hygienic and medical work the 
attendance records have reached unprecedented heights 
in these usually irregular districts. The principals esti- 
mate that 90 per cent of the affected pupils have remained 
in school who would in the absence of this service have 
dropped out for several days. This fact is of vital signifi- 
cance to the schools and the community in view of the 
contention' that irregular attendance is the chief cause of 
backwardness and non-promotion, and that ill health is 
the chief cause of irregular attendance. It was found in 
New York that 43 per cent of the boys and 48 per cent of 
the girls of the 16,000 completing the eighth grade in 
1909 were absent from school from illness. The net loss 
through inattendance to the girls amounted to 3.5 per 
cent of the length of the term, and to the boys 3.2 per cent. 
The causes of these absences were: measles, 2,108; scarlet 
fever, 1,550; diphtheria, 1,002; pneumonia, 621; whoop- 
ing cough, 473 ; chicken pox, 387 ; mumps, 288 ; tonsilitis, 
251; typhoid fever, 219; rheumatism, 200; malaria, 151. 

2 AyeeSj Leonard P. Irregular Attendance — A Cause of Retarda- 
tion, The Psychological Clinic, Vol. Ill, No. 1, March 15, 1909. 



MEDICAL AND DENTAL INSPECTION 321 

Without any system of medical inspection and nurses' 
supervision in the New York schools, these absences would 
probably have been increased from minor infections such 
as those which prevailed in the Marion School. 

Since the work attempted in these stations has not con- 
templated a routine examination of every child, and since 
the form and completeness of the records kept have varied 
more or less with each inspector, it is impossible to state 
how many cases have been examined by the physicians since 
the work was launched, or how many defects (particularly 
the non-communicable, physical abnormalities) have been 
discovered, or what the relative proportions of different 
kinds of physical defects are, or precisely how the influence 
upon mental retardation differs with different defects, or 
what have been the subsequent effects upon the physical 
growth, the increase in body weight and the mental effi- 
ciency of the hygienic and medical treatment of the 
affected child. The magnitude of the inspection work may 
be inferred, however, from the records at the Murray Hill 
and Marion schools, where, during the months of January, 
February and March, 28,820 inspections were made. 
Moreover, I have been able to obtain three sets of reliable 
data, one from the printed records and two in response to 
a questionnaire. The first shows the ratio of the various 
physical defects obtaining among children in the better 
sections and congested districts of the city. During the 
academic year 1906-1907 the department of physical 
training of the public schools examined 30,000 children 
with respect to the conditions of the eyes, ears, nose and 
throat only, in grades three to seven. The following table 
is based upon the examination of 1,284 pupils in two 
schools, one in the 'East End' and the other in a congested 
district : 



East End 
Per cent 


Cong-ested 
District 
Per cent 




616 


6.4 


1.8 


32.4 


71.1 


27.8 


35.2 


5.2 


1.8 


8.9 


12.8 


45.1 


57.1 


12.1 


14.7 


1.3 


15.7 


27.8 


46.4 


18.55 


28.4 



322 MENTAL HEALTH OF SCHOOL CHILD 



Number examined 668 

Wearing glasses 

Defective vision 

Other symptoms of eye trouble. . 

Defective hearing 

Diseased ears 

Obstructed nasal breathing .... 

Habitual mouth breathers 

Teeth very defective 

Teeth very dirty 

Average 



Dr. L. W. Childs has more recently made a routine 
examination of 425 pupils in the lower grades (from the 
second to the fifth) in the Murray Hill School, where 97 
per cent of the school population is Italian, covering the 
ear, nose and throat, and has kindly supplied me with the 
results of his careful survey, to wit : 

Per cent 

Retraction of drum membranes of both ears 32 

Retraction of membrane of one ear 16 

Impaired hearing 22 

Enlargement of both tonsils 22 

Enlargement of one tonsil 3^/2 

Adenoids 13 

Impacted wax in ears 13 

Enlarged cervical glands 10 

Goitre 7 

Atrophic rhinitis 5 

Deviated septum 4 

Suppurating ears 2 

Hypertrophied inferior turbinals 2 



MEDICAL AND DENTAL INSPECTION 323 

In a still later examination of 120 sixth, seventh and eighth 
grade girls in the same school, 32 per cent suifered from 
goitre and 16 per cent from anemia. 

In a routine examination of the 972 pupils in the eight 
grades of Mayflower School (station opened March 25, 
1909), the inspector. Dr. S. A. Weisenberg, to whom I 
am indebted for a full report, found the most prevalent 
troubles to be the following : 

Per cent 

Pediculosis 51 

Defective eyesight 7 

Miscellaneous eye cases 13 

Eye troubles, total 20 

Miscellaneous throat cases 8.4 

Hypertrophied tonsils 4.5 

Tonsilitis 2.7 

Adenoids 2.2 

Adenitis 1.3 

Throat troubles, total 19.1 

Impetigo 9 

Injuries 8.2 

Miscellaneous ear cases 4.5 

Chronic rhinitis 1.6 

Nasal defects 1.3 

Nose troubles, total 2.9 

Over 78 per cent of these children were Jewish, nearly half 
of these being Russian Jews (47.9 per cent). 

That the conditions revealed by these medical surveys in 
Cleveland are paralleled in other centers of population 
has been shown in Chapter I. Of course, under the present 
indefinite standards of conducting school medical inspec- 



324 MENTAL HEALTH OF SCHOOL CHILD 

tion, and under the rather chaotic methods of recording 
the findings, it is not possible to state whether the nation- 
wide figures exaggerate or minimize the true state of 
affairs. School medical inspection work cannot command 
the respect of scientific men unless it is properly standard- 
ized. There is urgent need for the adoption of more uni- 
form and definite standards, practices and policies for 
conducting physical inspections in the schools. At present 
some inspectors record only serious affections or affections 
requiring treatment, while others record all sorts of minor 
or negligible defects. There is diversity of opinion as to 
the amount of deviation necessary to constitute sensory 
defects {e.g., of vision and hearing). Thus A. E. Taussig, 
M.D., maintains that the criterion of defective vision 
should be a degree of acuity less than ^%o- The methods 
of recording the results of the examinations differ widely 
in different systems. Many give no indication as to which 
are the principal defects discovered; many do not specify 
clearly the exact nature of the defects ; some group the 
secondary troubles with the primary, the contagious dis- 
eases with the non-contagious physical deviations, the 
temporary and curable ailments with the non-curable or 
protracted defects ; some give no individual records for 
visual and auditory acuity in comparative objective meas- 
ures for each eye and ear separately (although such infor- 
mation is of paramount value to the teacher in enabling 
her to seat uncorrected children judiciously) ; others omit 
the age, sex, nationality, grade, home and community con- 
ditions of the child (although such details are of surpass- 
ing importance, to enable us to correlate physical 
defectiveness and disease with age, sex, nationality and 
environment) ; and practically all omit reference to the 



MEDICAL AND DENTAL INSPECTION 325 

mental condition, disposition and behavior of the cliild 
prior to inspection and treatment, and nearly all lack a 
'follow-up' form of card on which to record the results of 
treatment upon the child's subsequent mental efficiency, 
disposition, deportment, health, increase in weight and 
physical growth and development. That the latter has 
received scant, if any, scientific study is no doubt due to 
the difficulty of obtaining pedagogical and psychological 
measures which shall be objectively and scientifically valid. 
The classroom registers and the judgments of the teachers 
surely have their values, but the grading and judgments 
of the teachers are so variable that to measure by them the 
child's increasing proficiency as the result of treatment in 
quantitative terms is out of the question. Nevertheless a 
'follow-up' system of recording the influence of various 
forms of treatment upon various kinds of pedagogical 
defects based upon the teachers' marks and opinions is 
better than no system at all, and is imperatively needed 
unless we are content to be empiricists in this newly organ- 
ized branch of community and school work. To develop 
this work aright we must have accurate knowledge of the 
influence of various abnormalities and of their treatment 
upon mental and physical development. Taussig has 
recently proposed a means of measuring the influence of 
physical defects upon school work ; and the same means 
might be used to measure the effects of treatment. He 
would calculate the average grade of proficiency for each 
age for the normal and defective pupils by multiplying 
the number of children in each grade by the number of the 
grade. The average grade can then be secured by divid- 
ing the result by the total number of children. This gives 
a quasi-objective measure, but, again, it assumes the 



326 MENTAL HEALTH OF SCHOOL CHILD 

accuracy of the teachers' marks and the correctness of the 
school classification. Assuming a fair degree of accuracy 
for the individual markings, the scheme offers an approxi- 
mate criterion for gauging the scholastic influence of 
physical orthogenesis. 

But a scheme by which to supplement the teacher's 
grades and opinions by means of careful psychological 
tests of the pupil's quickness of perception, rapidity of 
association, strength of immediate visual and auditory 
memory, strength of grip, abihty to spell and add, etc., 
carried out a short time prior to treatment and subse- 
quently at different intervals, will eventually command 
the attention of school medical inspection and psychologi- 
cal departments. Such tests are perfectly feasible and 
will enable us to quantify the influences of orthosomatic 
treatment upon the working capacity of the pupil (see 
Chapters XHI and XIV). 

But to return from this digression to the medical inspec- 
tion work in Cleveland. The conditions revealed by the 
volunteer inspections in the schools and the humanitarian 
work performed by the nurses and physicians in relieving 
needless physical suffering, which interfered with the 
working efficiency of both the child and the school, demon- 
strated to the Board of Education the urgency, on 
economic, educational and moral grounds, of establishing 
as an integral part of the schools a department of medical 
supervision and inspection. Such a department, under the 
administrative charge of the director of schools, was put 
into operation on the first of April. It has at its disposal 
an annual budget of $30,000. It has in its employ one 
supervisor at a salary of $3,000 per annum, fifteen medical 
assistants or inspectors at $100 per month for twelve 



MEDICAL AND DENTAL INSPECTION 327 

months per year, ten nurses at $60 per month the first 
year, $70 the second, $75 the third and $80 thereafter, 
and one clerk at $1,000 per annum. The department con- 
templates the inspection of all the pupils to determine their 
state of health and the presence of diseased conditions and 
physical anomalies. Teachers and parents will receive 
advice on the diseases and defects found, with recommen- 
dations for their reHef ; the pupils and teachers will receive 
advice on the safeguarding of their health, and suggestions 
will be offered respecting the course of study, construction 
of buildings, etc. Records in duplicate will be on file at 
the schools and the headquarters of the department, and 
will be sent home to the parents. These records zdll 
accoTnpany the child throughout his course in the grades. 
It is expected that the records will be made unusually 
complete and accurate. The city will be divided into 
fifteen districts, comprising about six schools each, with 
one physician and nurse in charge of each, making each 
physician responsible for inspecting somewhat less than 
5,000 children (each of the two hundred inspectors in 
New York has about 4,000 children under his care, while 
each of Chicago's one hundred has approximately 6,000). 
By thoroughly inspecting the first year entrants it is 
believed that the work will be materially lightened in the 
upper grades. Free treatment is not yet a part of the 
program. The rules and regulations of the department 
are made by the Board of Education and not by the Board 
of Health. School medical inspection should be under the 
administrative control of boards of education instead of 
boards of health. Actually in 1911 only 106 systems were 
under boards of health as against 337 under boards of 
education. 



328 MENTAL HEALTH OF SCHOOL CHILD 

n. Opening of the National Campaign on Oral. 
Hygiene Under the Auspices of the National 
Dental Association, the Ohio State Dental 
Society and the Cleveland Dental Society. 

In 1908 the Committee on Education and Hygiene of 
the Cleveland Dental Society reported a plan for dental 
education in the public schools of the city, embracing 
among other matters a course of lectures to be given to 
the teachers. The plan was censored and criticised by the 
Dental Society and given scant consideration by the Board 
of Education. Nothing was accomplished beyond the 
issuing of a bulletin of information on the care of the 
teeth by the superintendent of schools to the teachers, who 
were directed to impart the information to the children. 
Somewhat over a year later a free dental chnic was estab- 
lished at the City Hospital. The venture proved largely 
unsuccessful, due to the unfavorable location of the clinic. 
Inspection trips were then made to Boston, New York, 
Rochester, Birmingham, Ala., and other places for the 
purpose of studying the methods employed for the dental 
education of school children. At this juncture, the chair- 
man of the Cleveland Committee on Education and 
Hygiene became chairman of the Oral Hygiene Committee 
of the National Dental Association. With the oral 
hygiene headquarters established in Cleveland, and data 
available from the cities visited, the campaign began 
afresh. Permission was received from the Board of 
Education to conduct a dental survey in four representa- 
tive schools. This survey was made in one day by about 
forty dentists. The detailed results are embodied in the 
following table. The table is not absolutely accurate, 
owing to the haste with which the work had to be done, and 



MEDICAL AND DENTAL INSPECTION 329 

the occasional misinterpretation of the instructions by 
some of the examiners. Thus some examiners thought that 
'good,' 'fair' or 'bad' referred to the teeth only, and, 
therefore, some mouths were marked good when the oral 
conditions were unhygienic. The results thus rather 
minimize than overemphasize the actual oral conditions 
found. The figures from the Marion School are the most 
accurate. 



Murray 
Hill 



Doan. 



Waterson. 



Marion. 



Number of Pupils Examined. 
Condition of the Mouth : 

Good 

Fair 

Bad 

Condition of the Gums : 

Good 

Bad 

Use Tooth Brush : 

Yes 

No 

Teeth Filled : 

Yes 

No 

Malocclusion : 

Yes 

No 

Teeth containing Cavities 

Teeth Extracted 

Nationality : 

American 

German 

English 

Italian 

Russian 

Slavic 

Bohemian 

Swedish 

Irish 

French 

Norwegian 

Polish 

Number of Perfect Mouths . . . 
Number of Defective Mouths 
Number of Cavities 



346 
381 
134 



594 
253 



101 
762 



9 

843 



230 
633 



25 

4 
4 
828 
1 
1 



62— 7.17% 

802—92.83% 

3920 



132 
429 
117 



504 
169 



524 
161 



275 
404 



421 
452 



641 
69 



657 
1 
6 
1 



20— 2.9% 

671—97.1% 

4294 



135 
99 
63 



221 
73 



193 
100 



102 
191 



93 
169 



257 
14 



198 

20 

45 

7 



14— 4.69% 

284—95.31% 

1342 



824 

244 
336 
241 



447 
300 



243 
456 



72 
707 



343 

308 



745 
125 



116 
73 
11 

420 



2677 



13— 1.5% 

811—98.439! 

5505 



330 MENTAL HEALTH OF SCHOOL CHILD 

The 2,677 mouths examined contained 15,061 dental 
cavities, or an average per mouth of 5.6 (somewhat above 
the Worcester average, 4.85) ; in 2,145 mouths, or in 
about 80 per cent, the teeth were not filled; malocclusion 
affected 1,087, or somewhat over 40 per cent; in 1,479, or 
55 per cent, a tooth brush — the instrument that is 
mightier than the sword in national human defense — was 
never used; the number of defective mouths ranged from 
92 per cent to 98 per cent ; and practically 97 per cent of 
the mouths required some sort of hygienic attention or 
dental service to render the mouth healthy and function- 
ally efficient. As will be seen in the table, some of the 
defects are most prevalent in the schools with a pre- 
ponderant Italian population- — an indication of the rela- 
tion of unwholesome environmental influences and unen- 
lightened or poverty-stricken conditions in the home to 
unsanitary oral conditions. 

It will be of interest to recount some of the results of 
dental surveys in other cities. One of the first, if not 
actually the first, inspection was made in Russia in 1879. 
Defective dentures afflicted 80 per cent of the inhabitants 
of St. Petersburg. Of Berlin school children, 90 per cent 
were similarly affected (Ritter), and of 100,000 school 
children examined in diff^erent states of Germany, from 81 
per cent to 99 per cent had diseased teeth. In Ludlow, 
Mass., the 500 pupils examined (from eight to fifteen 
years old) displayed palpable neglect of dental cleanliness, 
very few used brushes, none had received any dental treat- 
ment aside from a few children who had had teeth 
extracted, bacterial deposits and malodorousness existed 
in varying degrees, some suffered from prolonged reten- 
tion of the temporary teeth, while still more had lost these 



MEDICAL AND DENTAL INSPECTION 331 

teeth prematurely, showing a disregard of the value of 
the temporary teeth. In New York, an expert examination 
was made of the teeth of 500 boys and girls from fourteen 
to sixteen who were applying for work certificates, on 
behalf of the Children's Aid Society. Less than 3 per cent 
of these had sound teeth ; 456 had 2,808 decayed teeth, or 
an average of about 6.1 each, 90 per cent of wliich could 
be saved by proper dental attention. Gangrenous pulps, 
or decayed pulps exposing the roots, were found in 247 
boys and 152 girls; and only 25 out of the 500 had 
received any dental care other than extraction. In an early 
inspection of all the pupils in Cleveland by the ward 
physicians under the direction of the Board of Health, 79 
per cent of the children were reported as suffering from 
decayed or defective teeth (see also Chapter I). 

With such distressing revelations as these — and the 
statistical data can now be multiplied a hundred-fold — it 
is little wonder that experts have come to regard caries of 
the teeth as the 'disease of the people,' a world-wide afflic- 
tion of civilized nations, and the unsanitary mouth, which 
is the gateway to the stomach, as the body's chief breeding 
place for pathogenic bacteria, a hidden source of infection 
little attended to because of its hidden character. And 
with these revelations the modern propagandist of the 
body hygienic has ralhed his forces about a new battle-cry : 
'Keep the mouth with diligence, for out of it are the issues 
of life.' 'Good teeth, good health' — is the modern ortho- 
genic tocsin. In no branch of public hygiene are such 
decisive results obtained and with such small cost as in 
the dental treatment of school children. 

The results of the Cleveland survey induced the Board 
of Education, in October, 1909, to grant the request of 



332 MENTAL HEALTH OF SCHOOL CHILD 

the National Dental Association, the Oliio Dental Society 
and the Cleveland Dental Society, to conduct dental 
examinations of all the pupils in the public schools during 
a period of one year, to treat gratuitously all indigent 
children so desiring, and to offer lectures in the school 
buildings to teachers, parents and pupils on the proper 
care and use of the teeth and mouth. On March 18, 1910, 
the formal opening of these clinics — four in public schools 
and one each in St. Alexis Hospital and the City Clinic — 
was signalized by a convention in Cleveland, at which 
addresses were made by the President of the National 
Dental Association, the Chairman of the Education and 
Oral Hygiene Committee of the Ohio State Dental Society, 
the Chairman of the Oral Hygiene Committee of the 
National Dental Association, the Commissioner of Health 
of Chicago, the Superintendent of Schools of Cleveland, 
the Dental Surgeon of the Naval Academy, the Mayor of 
Cleveland, the personal representatives of President 
Taft and Governor Harmon and others. The exercises 
included the formal dedication of the clinics and addresses 
on various aspects of school dental inspection. The con- 
vention marked the inauguration of a country-wide cam- 
paign for the organization of departments of dental 
inspection as integral parts of the public school systems 
of our cities. It is expected that one year of volunteer 
work in Cleveland will demonstrate that the work is one of 
the most needed and worthiest undertakings of the schools, 
whether viewed from an altruistic, educational or economic 
point of view. Special scholarship and deportment blanks 
will be kept on wliich records of the treatment will be made 
and of its effect upon the subsequent working efficiency and 
behavior of the cliild (see experiment described and 



MEDICAL AND DENTAL INSPECTION 333 

discussed in Chapters XIII and XIV). Special blanks in 
triplicate, containing charts of diseased dentures, will be 
furnished to the Director of Schools, the Cleveland Dental 
Society and to the pupil or teacher for the parent. 
Parents who desire treatment for their children on the 
ground of poverty must make application upon a separate 
'indigent' blank. The clinic patient will be supplied gratis 
with a brush, tooth powder, antiseptic wash, plastic (not 
gold) fillings and pulp and root treatments. The 
examiners and clinicians will be certified and assigned to 
their respective schools by the director of schools and the 
supervisor of dental inspection. The material equipment 
of the clinics is furnished by the National and Ohio Dental 
Associations, and the dentists and assistants (each 
examiner will have a woman assistant) by the Cleveland 
Dental Society. Each examiner will donate one week's 
services, or twelve half days. The lecture course will be in 
the hands of twenty men. The expense incurred by the 
Cleveland Society amounts, in cash equivalent, to about 
$3,491— $1,866 for examination work, $1,500 for chnic 
work and $125 for the lecture and educational work. 

Thus the year 1910 marks the introduction upon a 
volunteer basis of the first school dental clinic in the United 
States, six years after the first school dental clinic was 
established in Strassburg by Dr. Jessen. (It is stated that 
the first free dental clinic in the world was established in 
Rochester over twenty-five years ago and that the first 
school dental clinic was established in the same city 
February 23, 1910.) The Strassburg clinic is open to all 
school children without charge, and is manned by regularly 
registered dentists, under municipal control. School clinics 
of the same type have since been established in thirty-five 



334 MENTAL HEALTH OF SCHOOL CHILD 

or more German cities. With the better understanding 
which we now have of the effects of the unhygienic oral 
cavity upon the health, happiness, mental and physical 
efficiency and the morals of the child, it is predicted that 
the spread of the school dental cKnic will be no less rapid 
in our own country. (At this writing, it is reported that 
over 200 American cities are providing dental inspection. 
In 1910, J. H. and Thomas A. Forsyth of Boston donated 
$500,000 for the establishment of a clinic to provide free 
dental service to any child from early childhood to the age 
of sixteen.) It is reported of a certain juvenile judge that 
he always has the teeth of his youthful culprits examined 
before he imposes sentence ; and not infrequently the 
penalty imposed is a trip to the dental chair. Match 
manufacturers sub j ect their employees to dental inspection 
and exclude all persons with decayed teeth. Phosphorous 
necrosis has thus disappeared among match workers. 
Some hidden cavity in a tooth or unclean surface is often 
a focus for bacterial deposits. Such foci serve as the 
breeding places for germs causing acute infections, scarlet 
fever, diphtheria and tuberculosis, and enlargements of 
the glands of the neck and throat may occur through 
absorptions from these cavities. The gases and poisons 
generated in an unsanitary mouth and the pain from 
toothache often produce general and gastric neurasthenia, 
indigestion, ill health, irritability, bad temper, mental 
inefficiency, inability to concentrate attention, bad morals, 
and, it is alleged, even insanity. The machinery for 
discovering these conditions in the schools — the only 
organized social agency with anything like police power — 
will come inevitably everywhere. Will we get the machin- 
ery for rectifying these conditions, the school dental dis- 



MEDICAL AND DENTAL INSPECTION 335 

pensary in addition to the school dental inspection station? 
Whether or not compulsory school clinics are desirable, 
some form of pressure cannot be dispensed with if this 
work is to realize proper returns upon the investment. 
In one of the German cities such pressure is secured by 
barring children with diseased teeth from the privileges of 
the recreation grounds, forest school and vacation colonies. 
'Without good teeth there cannot be thorough mastica- 
tion. Without thorough mastication there cannot be 
perfect digestion. Without perfect digestion there cannot 
be proper assimilation. Without assimilation there can- 
not be nutrition. Without nutrition there cannot be 
health.' Moreover, without the retention and the whole- 
some development of the teeth there cannot be beauty of 
countenance. 



REFERENCES. 

Ayres, L. p. The EfFect of Physical Defects on School 
Progress. The Psychological Clinic, Vol. Ill, No. 3, 
May, 1909, p. 71. 

Cornell, Walter S. The Relation of Physical to Mental 
Defect in School Children. The Psychological Clinic, 
Vol. I, No. 9, February, 1908, p. 231. 

Mentally Defective Children in the Public Schools. The 
Psychological CHnic, Vol. II, No. 3, May, 1908, p. 75. 
The Physical Condition of the School Children of the 
School of Observation, University of Pennsylvania. The 
Psychological Clinic, Vol. Ill, No. 5, October, 1909, p. 
134. 

The Need of Improved Records of the Physical Condi- 
tion of School Children. The Psychological Clinic, Vol. 
Ill, No. 6, November, 1909, p. 161. 



336 MENTAL HEALTH OF SCHOOL CHILD 

Ebersole. Report on the Proposed Dental Educational and 
Hygienic Work in the Cleveland Schools. Dental Sum- 
mary^ February and March, 1910 (reprinted in the 
Dental Brief and Dental Digest, same issue). 

Elson, W. H. Annual Report of the Superintendent of 
Schools, Board of Education, Cleveland, Ohio, 1907, p. 
38. 

Emery. Medical Inspection in Two Worcester Schools. The 
Pedagogical Seminary, Vol. XVII, No. 2, April, 1910, 
p. 111. 

Greene, Mary Belle. A Class of Backward and Defective 
Children. The Psychological Clinic, Vol. Ill, No. 5, 
October, 1910, p. 125. 

GuLicK and Ayres. Medical Inspection of Schools, 1913. 

Holmes, Arthur. Can Impacted Teeth Cause Moral Delin- 
quency? The Psychological Clinic, Vol. IV, No. 1, 
March, 1910, p. 19. 

McHenry. Medical School Inspection in Cleveland. The 
Cleveland Medical Journal, Vol. VIII, 1909, p. 338. 

Orr. The New Medical Inspection Department in the Cleve- 
land Public School. The Cleveland Sunday Leader, 
Magazine and Workers' Section, March 13, 1910. 

Russell Sage Foundation. What American Cities Are 
Doing for the Health of School Children, 1911. 

Sneed, C. M., and Whipple, G. M. An Examination of the 
Eyes, Ears and Throats of Children in the Public Schools 
of Jefferson City, Mo. The Psychological Clinic, Vol. 
II, No. 8, January, 1909, p. 234. 

Taussig, A. E, The Prevalence of Visual and Aural Defects 
Among the Public School Children of St. Louis County, 
Mo. The Psychological Clinic, Vol. Ill, No. 6, Novem- 
ber, 1909, p. 149. 



CHAPTER XVII 

EFFICIENCY IN SCHOOL ORGANIZATION AND 

THE CONSERVATION OF THE MENTAL 

HEALTH OF CHILDREN^ 

The preservation and promotion of the mental, physical, 
educational, social, moral and vocational efficiency of the 
individual is not only the most vital problem that confronts 
each human being, mature or immature, but it is also the 
problem par excellence of the family, state and school. 
Owing to the disintegrating, and ofttimes demoralizing, 
influences exerted upon the institution of the home by the 
modern urbanization and industrialization, together with 
the frequently attendant pauperization, of a large part of 
our population, the obligation for the reclamation, conser- 
vation and improvement of child life is being largely trans- 
ferred to the state. But we are rapidly learning that the 
state has no agency which is able adequately to cope with 
the numerous problems involved except the public schools. 
And so the obligation to care for the welfare of the chil- 
dren is more and more being placed primarily, and very 
properly, upon the institution of the public schools. This 
is the only institution established under state control in 
all communities which can be invested with sufficient police 
power and which commands in largest measure the 
confidence of the community. 

1 Delivered, in part, at the Annual Meeting of the Child Study 
Department of the Pennsylvania State Educational Association, 
Pittsburgh, December 31, 1913. 



338 MENTAL HEALTH OF SCHOOL CHILD 

That the public schools have responded to the new 
demands made upon them by the people during the last 
decade or two is well known. They have assumed func- 
tions not dreamed possible only a few years ago. Witness 
the growth of the social center or wider-use-of-the-school- 
plant movement, the establishment of evening continuation 
and trade school work, the introduction of school feeding, 
the organization of school medical inspection systems, 
school medical, dental and psychological chnics and play- 
grounds and social service departments. Splendid as have 
been these recent attempts to reformulate, revitalize and 
modernize the functions of the schools, and wonderful as 
are the results which have already been attained, it must, 
nevertheless, be admitted that we are even now but in the 
beginnings of the new order of things — of a new movement 
of social and educational reconstruction which is destined 
to sweep over all the land. 

Among the forces tending toward a more efficient 
organization of school work is the growing recognition of 
the fact that the basic condition of efficient instruction and 
of the effective conservation of the mental health and 
special talents of children is the adjustment of the edu- 
cative processes to meet the varying needs of varying 
children, and the adjustment of the individual to his social 
and vocational environment. Education, indeed, is funda- 
mentally a process of adjustment. But only a few of the 
best modern school systems (leave alone the average or 
poor ones) have thus far succeeded in making a measur- 
ably complete adjustment of the educational agencies to 
the varied needs of 'all the children of the people,' and the 
varied needs of all the communities of all the people. It 
is the purpose of this paper to emphasize the fact that 
many, if not most, of the schools of the country fail 



SCHOOL ORGANIZATION 339 

properly to conserve the educational health of all their 
pupils because they fail to adjust the processes of the 
schools to the individual requirements of the pupils. This 
often renders much of the work of intellectual and moral 
instruction and training quite unscientific, inefficient or 
nugatory. 

Before attempting to preach a moral, however, we 
should first be reasonably certain about our facts. Before 
attempting to advise or prescribe, we should thoroughly 
scrutinize the evidence and accurately diagnose the case. 
Only after the existence of defects in the existent social, 
educational, or industrial order has been proved, is the 
critic or advocate ready for the public forum, and only 
then will he receive the critical attention and arouse the 
determined action of thoughtful people. It was the expos- 
ure of the demonstrated existence of repellent conditions 
in the Chicago slaughter-houses and stock-yards that led 
to the enactment of meat inspection laws. It was the high 
degree of refinement and differentiation of medical diag- 
nosis that led to specialization in medicine, to the develop- 
ment of various kinds of medical specialists, and which 
made imperative the organization of various kinds of hos- 
pitals and the differentiation of wards and clinics within 
hospitals. Just so surely as the refinement of scientific 
medical diagnosis has led to the development of new 
specialties in medicine, which has resulted in the improved 
differential remedial treatment of sick people, so surely 
will the refinement of scientific educational diagnosis 
develop new specialties and new methods of treatment in 
education. One of the peculiar benefits of this advance 
step, toward which education is surely tending, is that the 
schools (like the hospitals in respect to medical care) will 
develop differential or remedial or corrective educational 



340 MENTAL HEALTH OF SCHOOL CHILD 

treatment designed to meet the individual needs of all 
those children who differ from the standard of mental and 
pedagogical health in the same sense that different kinds 
of sick persons differ from the standard of bodily health. 
When our schools have been organized scientifically to 
diagnose educationally abnormal pupils as hospitals are 
now organized to scientifically diagnose sick people, then, 
and then only, will the schools be prepared intelligently 
maximally to conserve and to improve the mental, educa- 
tional, moral and physical well-being of all the children, 
and economically and efficiently to train them for the 
social, civic and vocational responsibilities for which they 
are fitted. Then, and then only, will the work of rearing 
children be made as dignified and as scientific as the work 
of raising cattle and horses. Then, and then only, will 
school supervision be made efficient, and school organiza- 
tion minister effectually to the needs of all the children. 
But I have anticipated my conclusions in the preamble. 
I must therefore proceed at once to present some facts to 
justify the above assertions, which may sound to you like 
the 'pipe-dreams' of a beclouded mind. What you demand 
are actual concrete facts — facts which are capable of 
duplication and verification in any large school system 
anywhere. Nowhere are such facts — abundant, verifiable, 
incontestable — more easily accessible than in the clinic files 
of the modern well-organized psycho-educational clinic. 
The facts now to be presented consist of a dozen clinical 
pictures selected from the files of the educational clinic in 
the School of Education of the University of Pittsburgh. 
These pictures fail to furnish an adequate idea of the great 
variety of educationally unusual children — some easily 
diagnosed and others extremely baffling — which have been 
coming to the clinic for examination from various sections 



SCHOOL ORGANIZATION 341 

in Western Pennsylvania. However, the cases discussed 
will not only furnish clinical pictures of the two opposite 
types of educational deviates — the subnormal and the 
supernormal — but they will also give a faint idea of the 
great variety of subtypes of abnormal children which will 
be found within any given classification, or within the same 
grade of mental arrest or acceleration, and which must be 
adequately differentiated unless the public will continue 
to be satisfied with the type of crude and amateurish 
educational diagnosis which is now tolerated in most 
school systems. 

I shall begin with the subnormal cases, using the word 
subnormal in its broadest connotation, as inclusive of all 
cases on the minus side of the curve of distribution. I 
shall first present five types of imbeciles, pointing out the 
moral for the schools and for the community in connection 
with the discussion of each case. It is well to dwell on these 
cases for two reasons : first, because it sometimes happens 
that these cases never get to the schools and therefore 
receive no educational attention whatsoever ; second — 
and this happens more frequently — because all types and 
grades of imbeciles actually do get to the schools, and 
when there they are scarcely ever recognized by the 
teachers, principals, nurses or school inspectors, unless 
teachers and inspectors have taken special courses on 
feeble-minded and backward children. The claim has 
frequently been made, and presumably still is made, in all 
sections of the country by teachers, superintendents and 
medical inspectors that cases so low-grade as imbeciles, 
particularly the low-grade imbeciles, never get into the 
schools. We now know that this statement is without 
foundation. I shall first cite two cases, however, which did 
not receive any school instruction. 



342 MENTAL HEALTH OF SCHOOL CHILD 

Case 1 

My first case is an Irish-American girl, aged eleven 
years eleven months at the time of the clinic examination 
in November, 1913. 

She is reported to have been 'a fine, healthy babe,' 
weighed twelve pounds at birth, nursed for one and a half 
years. Cerebro-spinal meningitis, accompanied by con- 
vulsions at the time of teething during the tenth month, 
left her sickly, fretful and backward. The first teeth 
did not 'come through' until the age of two and a half 
and the second set began cutting during the tenth year. 
The anterior fontanelle did not close until about three. 
At three she was too weak to walk, stumbling and falling, 
but walked unsupported at about the age of four; the 
control of the fundamental reflexes was acquired at about 
four. Measles at four and a light attack of pertussis, 
and scarlet fever, at five. Speech has remained unde- 
veloped except for very few words and various inarticu- 
late sounds (nuh=:no; uh-huh=:yes lahr= Jennie, her 
sister; nah=:her usual response). 

Eats heartily and sleeps soundly at present. Table 
manners good but cannot sip soup ; drinks it and slobbers 
on clothes. Usually good-natured, but has spells of stub- 
bornness, displays violent temper when aroused and will 
chase boys on the street who annoy her. 

Home conditions and home treatment fair. Is able to 
scrub floor, iron dust-cloths, sew fairly well, dress herself, 
but cannot button her clothes or wash her face clean or 
go errands. She cannot persist in her work. 

The clinic examination disclosed the presence of several 
dental cavities and strabismus due to muscular paralysis. 
Dental treatment was advised and has been provided. 

In anthropometric development^ she was quite normal. 
2 In all cases the anthropometric measurements are compared with 
the norms furnished by Smedley (percentile and age tables), Boas, 



SCHOOL ORGANIZATION 343 

In standing and sitting height^ head circumference and 
weight she was equal to the normal twelve-year-old girl, 
while in strength of right-hand and left-hand grip she 
ranked between nine and ten and ten and eleven, respec- 
tively. Her weight was correct for her height and the pro- 
portion between standing and sitting stature was also 
right (ponderal index equals 23.1, normal equals 23.3; 
statural index equals 53.2, normal equals 53.2). 

But mentally she tested only to about the age of three, 
while in motor development she was like a child of four. 

She was unable to copy a square, could not show her 
right hand and left ear except in a vaccillating manner, 
could not state the number of fingers on the two hands, 
but was sometimes able to hold up as many fingers as the 
number of fingers held up by the examiner. When shown 
a key and asked what it was she picked a key from her 
mother's handbag. Cannot distinguish between pretty 
and ugly pictures or execute a triple order, is sensitive to 
the presence of observers, but makes fair effort to respond 
and some effort to talk. 

Here is afforded a very interesting case of partial 
aphasia superposed upon a background of imbecility of 
developmental origin (due to inflammation of the pia 
mater), with practically normal anthropometric develop- 

Hastings, Qu^telet and Montessori. The norms from these authori- 
ties are sometimes discrepant, whence it has at times been necessary 
to make approximations. In all cases the intellectual age has been 
determined by the Binet-Simon scale, 1908 edition, the author's guide 
(Experimental Studies of Mental Defectives, Baltimore, 1912, pp. 
116f.). The motor age has been determined by the Vineland form- 
board. Data are also given for the two Healy-Fernald construction 
puzzles (Tests for Practical Mental Classification, Baltimore, 1911. 
It has not yet been proved that these construction puzzles have the 
value for mental diagnosis claimed for them. I have a number of 
instances where the child failed utterly to do the tests on one occasion 
but had no difficulty on another occasion. The outcome, apparently, 
depends too much on chance). 



344 MENTAL HEALTH OF SCHOOL CHILD 

ment. Although ahnost twelve years of age, this child 
has never received any systematic instruction either at 
home or in school. The educational possibilities of a case 
like this are, to be sure, quite limited. But corrective 
speech work, applied several years ago, would not have 
been entirely futile, and the right kind of sensori-motor 
training would have developed a degree of motor skill 
which would now enable this girl to make more profitable 
use of muscles which are not very far below normal 
strength. The time almost invariably comes in the lives of 
these unfortunates when society must support them, and it 
is only a just demand of society that the schools so train 
them in their youth that they may be able to contribute 
more to their own support in institutions than they can do 
if left to grow up untrained in their homes. 

Case 2 

The following case, an American girl, age sixteen years 
eleven months at the time of the examination in December, 
1912, grades about the same in intelligence, but represents 
a different type. She furnishes another illustration of 
educational neglect. 

According to the record, her birth was normal and on 
time, weighed about eight pounds at birth, bottle fed, 
appeared bright and intelligent as a babe but did not 
kick like the normal child; six or eight teeth appeared 
simultaneously during the sixth month; walked at about 
the age of two but required braces until three ; began to 
talk more or less at three or four. Mental peculiarity first 
noticed by parents at six years, particularly the lack of 
progress in speech development. Pubertal development 
somewhat retarded (first menstruation at fifteen and one 
half years). 



SCHOOL ORGANIZATION 345 

Chicken-pox, mumps and measles during fourth year; 
scarlet fever, followed by diphtheria, rendered the child 
weak for five or six weeks. Always more or less nervously 
unstable, easily excited, 'nervous jumps,' but without 
violent outbreaks. 

At home, she is amiable and obedient, understands 
commands and is willing to do what she can compre- 
hend. Can sweep, scrub, set table, put on shoes and 
stockings. Does not know the alphabet nor understand 
the meaning of such words as 'or' and 'if,' and cannot 
read or count. 

Mother very weak and nervous before child's birth; 
father not always temperate; one cousin of father 'weak- 
minded'; a child of father's sister 'acted peculiarly' and 
could not talk; a child of the daughter of a sister of the 
father had chorea. 

Attended school a few days at the age of six, but was 
sent home because she was 'too nervous.' No other 
schooling. 

The examination at the clinic revealed an excitable 
but pleasant type of imbecile, with pronounced neurotic 
stigmata, gross finger twitches, occasional nervous starts, 
two slightly enlarged tonsils, two carious teeth, an 
asymmetrical chest and a very unsymmetrical physical 
development. In head girth, she graded eight years, in 
standing and sitting height, over eighteen years (statural 
index equals 52.7, normal equals 52) ; in weight, a little 
over fifteen (ponderal index equals 22.7, normal equals 
23.6) ; in strength of grip, about normal, but in vital 
capacity notably deficient. She is thus both too tall 
and too light and her head is exceptionally small. Her 
speech was very indistinct; she was color blind and pos- 
sessed very little comprehension of form. 

Intellectually, she tested at about three and a half 
years. 



346 MENTAL HEALTH OF SCHOOL CHILD 

She knows the value of the four smallest United States 
coins^ can point to her nose, eyes and mouth, names a 
knife and a key, knows her sex and can distinguish the 
diiFerence in weight between six and fifteen grams. She 
can repeat only the last of two digits or the last word of 
six syllables pronounced to her, says she has two fingers 
on her right hand, makes no reply for the left, and two 
fingers on both hands. 

This girl had been examined repeatedly during the last 
ten years, but the mother had never yet been told what was 
fundamentally wrong with her — a low degree of imbecility 
of the simple and excitable type, probably of combined 
primary and secondary origin. 

Because the girl was able to understand a little and do 
a few things, the mother had been permitted to continue 
to indulge the fond, but vain, belief that she would some 
day 'grow out of it.' She was, however, assured at the 
clinic that her girl will never advance beyond a child of 
four or five, that she will need Hfelong protection, 
especially against the exploiters of defenseless girls of her 
type, and that, as she had already passed the pubertal 
epoch, she should be given the protection of institutional 
care, especially if such protection could not be guaranteed 
at home. As a result of this advice, application was filed 
about a year ago for her admission into the state institu- 
tion at Polk, but it has thus far been impossible to get 
her admitted. 

In theory, the public schools should not be required to 
train any child below the level of high-grade imbecile. In 
practice, however, they are forced to accept these children, 
unless society is satisfied to have them idle their time away 
in the homes or roam the streets, as so many do, and drift 
into vagabondage, prostitution and criminality. No state 



SCHOOL ORGANIZATION 347 

in the union has sufficient institutional provisions to accom- 
modate 25 per cent of all its feeble-minded children. 
Moreover, many parents, owing to the sympathy which 
they feel for their unfortunate progeny, refuse to insti- 
tutionahze them (and will not do so in the absence of 
mandatory laws), and cannot reconcile themselves to 
allowing them to remain in institutions even after they 
have been admitted. This may be illustrated by the 
following case who was admitted, after special pleadings 
had been made, to the state institution. 

Case 3 

A boy, aged nine years ten months at the time of the 
examination in May, 1913. 

The record indicated that the child was born normally, 
the last of eight children from the second husband; age 
of mother and father at the time of child's birth forty- 
two and forty-eight, respectively. He was unable to 
nurse after the eighth week, thenceforth bottle fed; 
developed 'catarrh' from cold contracted during the third 
week; nose operation at one and a half years, nasal 
obstruction removed at two and a half; same operation 
repeated in the same nostril at three and a half; nose 
operation again in November, 1911. Has been examined 
again and again, but mother has never been told that 
there was anything wrong except nasal obstruction, 
catarrh and adenoids. Fell on the forehead at one and a 
half years; mumps at four, typhoid-pneumonia at five, 
scarlet fever at five and a half; frequently suffered from 
styes; has been subject to enuresis. The mental pecu- 
liarity (slow development) was noticed by the mother 
between the first and second years. 

Restless and active in disposition, always doing some- 
thing. Enjoys roller-skating. Able to dress and feed 



348 MENTAL HEALTH OF SCHOOL CHILD 

himself. Bad temper at times, but obedient if taken in 
right way. 

Started to kindergarten at five and a half ; at seven, was 
placed in the first grade, but was soon returned to kinder- 
garten; at eight, was again advanced to first grade, where 
he went over the first half year's work three or four 
times with as many different teachers ; then was advanced 
to lA; he learned to write his name and a few words, 
although they meant nothing to him ; but could not learn 
to count. 

The clinic examination revealed a diminutive, restless 
type of boy, crying because he was afraid his nose would 
be operated on, suffering from rhinitis, pharyngitis and 
running ears ; he had a tongue slightly fissured trans- 
versely, stubby fingers, with the little finger somewhat 
inturned, rather sandy hair, a rounded, diminutive head, 
with a girth less than for a six-year-old boy. In standing 
height and weight he had a development of seven and a 
half years, in sitting height six and a half, in hand grip 
between eight and nine for the right hand and about nine 
for the left hand. Thus in physical development he 
ranges from the child of six to seven and a half, while 
his manuometry is about normal. Relatively to total 
stature his trunk is too short, but his weight is about right 
(statural index equals 53.2, which is about normal for 
age twelve ; ponderal index equals 23.7, normal equals 
23.5). 

At the age of nearly ten years he had an intelligence of 
only four and a half years, which is less than the intelli- 
gence he should have had when he first entered the first 
grade. His motor development was even less, namely, four 
years. His mental development is thus from two to three 
years inferior to his physical development. 

He is unable to repeat three numbers or six syllables ; 
does not know which is his right hand and left ear, says 



SCHOOL ORGANIZATION 349 

he has three fingers on the right, four on the left and six 
fingers on both hands ; says he is seven years old, cannot 
distinguish pretty from ugly faces, cannot state whether 
the time of the day is forenoon or afternoon, or copy a 
diamond or square, or locate missing parts in pictures. 
Says a horse is a horse, a dog is a dog, mamma is a 
mother, a table is 'table cover,' a chair is 'make one table 
chair.' Calls a quarter five cents, names red and blue 
correctly, but calls green blue and yellow red; says three 
two and three one cent stamps are eight stamps and cost 
ten cents. Is able to read such monosyllables as 'in,' 'it' 
'to.' 

This child is a mongolian imbecile, although not so 
easily recognized as such because of the attenuation of 
the mongoloid characteristics. Mongolian defectives 
unusually attain a mentality of about five years, rarely 
falling below four or exceeding seven. They usually come 
from the later pregnancies of parents of between forty 
and fifty of good hereditary qualities. Another boy with 
glaringly obvious mongolian features, six years old, who 
was more recently examined at the clinic, had a mentality 
of about two years and was the tenth of a family of 
fourteen children. He had been examined more than a 
dozen times and had been treated for all kinds of troubles, 
but the mother had never been told before that he was an 
incurable mongolian imbecile. It is very important to 
recognize this type early for two reasons : first, because 
these children are naturally affectionate and agreeable 
Avhen understood and properly treated, but quite mis- 
chievous, stubborn and irascible when not understood. 
Unfortunately they are rarely understood in the home, 
school or on the playground, where they are teased and 
bullied. Second, because they require differential educa- 



350 MENTAL HEALTH OF SCHOOL CHILD 

tional treatment in special classes. It is a waste of time 
to try to train these children to read, write and cipher, 
while speech training yields very meager results because 
of their Hmited intelligence. They should be trained in 
simple domestic and industrial tasks which do not entail 
very much strain on their vascillating attention. The 
proper place to train them is in state institutions, but 
unfortunately, as has been said, it is difficult to persuade 
the parents to part with them while they are young and 
plastic and to keep them in commitment once they are 
admitted. Case 3 was admitted to the state institution at 
Polk in August, 1913, but was removed after only three 
weeks of residence by his mother. Until we have mandatory 
commitment laws the public schools will be obliged to train 
low-grade defectives. But they should under no circum- 
stances be permitted in the regular classes, there to waste 
their years on work which has utterly no meaning or value 
for them, there to monopolize the time of the teacher (but 
some teachers, I have found from first-hand reports, 
ignore them and let them sit idle), and there to rob the 
normal and bright pupils of the advantages which by 
right are theirs. It looks almost like criminal negligence 
on the part of the school administration to have kept this 
child two or three years in the first grade. There is a fine 
irony in calling education an art based on scientific 
principles so long as this state of affairs is permitted to 
continue in the public schools. Some types of defectives, 
it is true, cannot be infallibly diagnosed at four or five 
years of age because the deficiency accumulates gradually 
and is not very patent at four or five, but not so with this 
type of defective. 

To what an extent the public schools are wasting the 
people's funds — of course not intentionally, but because 



SCHOOL ORGANIZATION 351 

of the failure to provide the means for scientifically classi- 
fying pupils — by trying to train in the regular classes 
both low- and high-grade defectives will appear from a 
consideration of the following high-grade imbeciles. 

Case 4 

An American boy, aged eleven years eleven months at 
the time of the examination in December, 1913. 

From his history we learned that he was the fifth born 
of nine children, two of whom died in infancy ; he was 
diminutive at birth, bottle fed for one and a half years, 
unable to sit up until one and a half, unable to walk until 
three, although he is reported as talking at about two; 
neglected, poorly nourished and puny as a babe. 

The present home conditions are reprehensible from 
the hygienic, sanitary and moral points of view. A four- 
room tenement house, lacking a bath and abounding in 
dirt and vermin, in a densely populated section, is occu- 
pied by ten persons. Seven children sleep in a small, 
unventilated bedroom, three boys in one bed and four 
girls in another. The food supply is inadequate in quan- 
tity and quality. The home life is upset and disturbed 
and the children are neglected and poorly disciplined. 
This boy spends much of his time roving around and 
playing in the streets. 

The father, now a bookkeeper and apparently a drug 
fiend, formerly held an educational position in a higher 
institution of learning in the state of Pennsylvania, and 
springs from a stock having several illustrious names to 
its credit. The mother was subject to scrofula during 
the first sixteen years of her life, and apparently is of 
inferior stock. 

The boy entered school at six, has been very irregular 
in attendance and is reported as a 'total failure,' poor in 



352 MENTAL HEALTH OF SCHOOL CHILD 

all branches, but best in music. At twelve he can count 
to ten, but cannot add, multiply, divide or subtract, can- 
not read or spell, is very poor in writing and spelling, 
and at the end of fifty-three months of schooling he is 
still in a regular first-grade class. The school report 
indicates that he is chatty, sociable, good-natured, kind, 
cheerful, impulsive, but also restless, nervous, at times 
excitable with outbreaks of laughing or of destructive 
tendencies. He inclines to be heedless of reproof, 
although he takes reproof with good grace, and is like- 
wise heedless of danger. He is careless, slovenly and 
'acts like an old man of seventy.' 

The examination at the clinic revealed a poorly nour- 
ished child with eight dental caries, two enlarged tonsils 
(for which dental and medical care was recommended, 
but nothing has thus far been done owing to the indiffer- 
ence of the father), and an anthropometric development 
ranging from about five to seven years. His standing 
stature was nearly equal to seven, his bust, weight and 
vital capacity nearly equal to six and a half, and his head 
girth less than five. On the other hand, in strength of 
grip he ranged between eight and nine years, and his 
weight was about right for his stature (although the 
ponderal index was 23.2 instead of 22.8, normal for 
height), but his bust was too long (index of stature 
equals 55 instead of 53; brachyscelous type). No one of 
his two sisters and his two brothers, varying in ages 
from eight to fourteen years, who were examined in the 
clinic, had a head girth equal to the normal seven-year- 
old child, while the average for all the five cases was less 
(19.5 inches) than for the five-year-old boy or girl. 

In the clinic, on superficial examination, he appeared 
bright, but with a highly distractable attention, his 
speech was distinct, fluent, but also glib, and he took 
delight in talking about his interests and in narrating his 



SCHOOL ORGANIZATION 353 

possible and impossible experiences — among others that 
on hallowe'en he had dressed up and pointed a make- 
believe revolver at a man^ securing from him twenty 
dollars^ which he had deposited in his bank at home. 

His intellectual age was only about six years, while 
his motor development was about seven and a half. In 
this case there is a fair correspondence between the 
physical and mental retardation. 

He said he had ten fingers on the right hand, eight on 
the left and two hundred on both hands ; thirteen pennies 
were counted as seventeen ; nine cents' worth of stamps 
cost fifty-two cents; 'in' was read as 'it,' 'bed' as 'ed' 
while 'to' was read correctly; he was unable to write from 
dictation, to count backwards, to state the difference 
between common concepts, to select in order five weights 
differing by three grams, or to give descriptive definitions. 
Monday, October 13, 1913, was said to be 'Monday, May 
34, second year.' He named the four smallest coins, 
recognized the four fundamental colors and repeated the 
week days correctly. 

This boy is a perfectly typical quasi-microcephalic, 
unstable, high-grade imbecile of congenital origin, whose 
condition is possibly aggravated by insufficient feeding and 
bad home conditions ; but after five years of schooling in 
the same grade he was not recognized by the school force 
as a true imbecile, but only as a case of marked stupidity 
or backwardness, complicated with a certain degree of 
waywardness. For over five years he has been permitted 
to mark time in the regular grades, but has practically 
nothing to show for his years of toil and trouble, the 
teacher's labors have accomplished merely negligible 
results, and the schools have wasted for the instruction of 
this boy alone at least $150 of the taxpayers' money in the 
vain attempt to educate an imbecile as if he were a normal 



354 MENTAL HEALTH OF SCHOOL CHILD 

child. It is almost incomprehensible that we should toler- 
ate in this day of scientific efficiency such wasteful expendi- 
tures of the public funds in the education of misfit pupils 
in the regular grades. This boy, at the very beginning 
of his school career, should have been given an educational 
examination by a competent educational examiner, supple- 
mented by a medical examination, and then should have 
been assigned to a special class. The teaching of reading, 
writing, language and arithmetic by ordinary methods is 
unavailing for all imbeciles and for most morons. Taught 
the things they are able to master, imbeciles can be made 
measurably efficient in the very humble tasks of life. 

Incidentally I may say that the school records of the 
five children from this family examined in the clinic are 
one series of failures. In the aggregate, these children 
have spent 24.5 years in school, but have completed only 
12 years of work. They have thus repeated at least 12 
years. Since the cost of instruction for each grade pupil 
in the schools of this system amounts to $30 a year, the 
economic loss to the community amounts to $360. This, 
of course, does not include the added outlay required to 
provide equipment and seating for these repeaters, nor 
does it include the educational and economic loss which 
the community ultimately must suffer from allowing 
deficient children to continue in the regular classes where 
they monopolize the teacher's time and impede the prog- 
ress of the normal pupils. And this family is only one 
among scores of similar or worse families in the same 
community. Witness the following record from another 
school of another group of five children from two related 
families, all of whom were examined in the clinic. One of 
the mothers was kidnaped at thirteen by her uncle, with 
whom she subsequently Hved without being married to him, 



SCHOOL ORGANIZATION 355 

and by whom she was infected with venereal disease. 
Fortunately only three of her eighteen children survive. 
The other woman also lived, without being married, \nth 
her uncle, a brother of the former man. Both men deserted 
the mothers of their children. From these unholy alliances 
have issued two boys with immoral tendencies, and one boy 
was at one time confined to an institution for the mentally 
disordered. The five school children (having an average 
head girth of only 19.9 inches, or about the same as the 
five children from the other family) have spent 29.5 years 
in the regular classes, but have completed only ten grades, 
thus having repeated fully 19 years of work at a cost for 
wasted instruction alone of $570. If the school efficiency 
expert wants proof of inadequacy in the organization of 
public school instruction let him turn to the files of a 
modern psycho-educational clinic, where he will find 
evidence galore of wasted educational endeavor and mis- 
spent funds. And for this state of affairs the intelligent 
public is itself to blame. I feel, however, that just so soon 
as the facts regarding the educational waste due to faulty 
organization of class instruction are fully realized by the 
public, every large school system will be forced, on purely 
economic if not educational or humanitarian grounds, to 
employ the services of expert educational examiners to 
properly classify and direct the education of all mentally 
unusual children. Let me emphasize that the quality of 
the total output of the schools will always depend very 
largely on the ascertainment of the individual peculiari- 
ties and needs of the pupils. But if the schools are under 
obligation to provide the type of classes and instruction 
which will conserve the mental health of special children, 
the obligation of the state is equally clear. The state 
must take steps to prevent the formation of families of this 



356 MENTAL HEALTH OF SCHOOL CHILD 

type. The schools must do their duty by the children 
already bom; but society must cut off the sources of 
supply. 

Case 5 

My next case, a boy of eleven at the time of the exami- 
nation in January, 1913, represents an extremely variable 
type of children, 90 per cent of whom stop short very early 
in their mental development, many of whom make Httle or 
no progress in school, tending rather to dement as they 
advance in years, many of whom manifest more or less 
frequent fluctuations in working capacity, and very few of 
whom should ever be permitted in the regular classes, not 
only because they require a special educational regimen 
but because their unpredictable paroxysmal outbreaks tend 
to frighten normal children and upset the order of the 
entire classroom. 

The record indicates that the boy was the fifth child, 
born normally, at birth weighed from seven to seven and 
one-half pounds, delicate and very cross as a babe, 
suiFered from indigestion, did not increase properly in 
weight, dentition delayed until the second year, did not 
walk or talk until about the third year. Membranous 
croup and measles between the third and fourth year ; the 
victim of many accidents; was run over by vehicles but 
never severely hurt ; several falls ; at about the age of six 
fell from the barn, cutting his head. At about nine, he 
developed diurnal and nocturnal grand mal seizures, 
recurring once every two or three weeks and later more 
frequently. They were not preceded by any aura, but 
were attended by loss of consciousness and contortions of 
the upper and lower limbs, and with post-convulsive 
tendencies to 'walk around and talk oiF.' One of his 



SCHOOL ORGANIZATION 357 

older brothers who died at six was reported to be 'just 
like him.' 

At the age of seven^ he was on three occasions sent to 
the primary room of the schools, staying in the aggregate 
about four months, but was dismissed because he was con- 
stantly 'playing with the other pupils and disturbing the 
room.' After this, he was given private instruction at 
home by five different teachers, but only in the literary 
branches. His worst reported fault was his inability to 
concentrate. 

In the clinic examination, he was found to have the 
intelligence of a child of 6.2 years, which was less than 
his chronological age when he entered school four years 
earlier. 

He was unable to state his age, to carry out three com- 
missions, to repeat a sentence of sixteen syllables, to read, 
to descry the missing parts in pictures, to write from a 
copy, to draw a diamond, to count thirteen pennies or to 
count backward from twenty to zero. He said that he 
had four fingers on his right hand, five on his left and five 
on both hands, that three two-cent and three one-cent 
stamps cost six cents, he called yellow green, and counted 
thirteen pennies as twelve. But he was able to give 
functional definitions, describe pictures and name the four 
smallest coins. 

Here is a typical case of epilepsy superposed upon a 
substratum of imbecility. Restoration to mental normal- 
ity in cases of tliis sort is out of the question even if the 
epilepsy were curable (which it is not, except in from 5 to 
10 per cent of the cases). All we can hope to do for this 
type of mental abnormality is to supply discriminating 
hygienic, dietetic and educational treatment. Whether 
educated in the home, school or institution, these children 
should receive the kind of manu-mental training which will 



358 MENTAL HEALTH OF SCHOOL CHILD 

specially prepare them for the type of industrial service 
which they can render in after life. These individuals will 
require constant surveillance and supervision both because 
of their seizures and because of their mental deficiency. 
Proper care can usually only be secured in the state 
colonies. Hygienic, adaptable occupations in the open air 
will contribute most to keep them healthy and happy. 
The obligation of the public schools is to afford epileptics 
(as well as other types of mental defectives) differentiated 
treatment in segregated classes between the ages of six 
and thirteen or fourteen, and then at the beginning of the 
pubertal period graduate them into the state colonies 
where they should at once be assigned congenial employ- 
ment. 

I shall now present a few defective types of a still 
higher grade of mentality. There are thousands upon 
thousands of these children in the schools of the nation, 
but they are very seldom recognized as 'defectives,' partly 
because their physical development and physical exterior 
are often quite normal, partly because they are able to 
apprehend the simpler relations of life fairly well, and 
frequently can talk quite fluently — a child who has 
attained a mentality of seven years or more usually has a 
free and fluent use of language — and partly because they 
frequently possess a degree of superficial brightness which 
deceives all except the experienced expert on mental defi- 
ciency. Some of the children of this type examined in the 
clinic who were indubitably feeble-minded have been pro- 
moted into the fourth or fifth grades, admitted into 
ungraded coaching-classes and elementary industrial 
schools, and placed, by so-called vocational counselors, in 
responsible positions which they were never able to hold, 
without the slightest suspicion on the part of the teachers 



SCHOOL ORGANIZATION 359 

or vocational directors that they were genuinely defective. 
There is no more difficult task in diagnosis than the 
diiferentiation of liigh-grade morons from border-cases 
and seriously backward children, and to trust anyone to 
make this diffei'entiation but an experienced psycho- 
clinical expert is preposterous. Surveys or estimates made 
by teachers, principals and medical inspectors of the num- 
ber of feeble-minded children in the schools are demon- 
strably worthless and misleading. These people do not 
recognize a high-grade moron or border-line defective 
when they see one ; to have amateurs attempt to diagnose 
these cases by formal tests is pernicious. 

Case 6 

The first of these cases, a German- American boy, aged 
fourteen years seven months at the time of the examination 
in November, 1912, presents no special diagnostic diffi- 
culties to the experienced examiner. 

He did not walk, talk or cut his teeth until over two 
years of age; was at one time badly burned under his 
right arm so that it was feared that he would perish ; 
pertussis at two and measles at six; 'holds his mouth 
open all the time just like his father and grandfather did.' 

Lives in a poor section but in a clean, well-ventilated 
and comparatively well-furnished flat. Plenty of food. 
The mother, apparently of low mentality, is divorced from 
the child's father, a drinker who would not support 
his family. Mother says the great-grandmother was 
peculiar. 

He started to school at six and at the end of eight years 
of schooling had reached only the second grade. He was 
then permitted to enter an elementary industrial school, 
where he remained last year without making progress. 



360 MENTAL HEALTH OF SCHOOL CHILD 

He did not return to school this year and his present 
whereabouts are unknown to the clinic. The school 
record indicates that he has learned to write fairly well, 
to spell a few words, and to add and subtract simple 
combinations. He cannot read or measure, but has a 
fairly good memory, and 'knows all the slang phrases and 
uses them constantly.' 

The boy was brought to me by one of the students in 
the clinic who is teaching in the aforesaid industrial school 
and who suspected that all was not right. He was found 
to suffer from three carious teeth and enlarged tonsils, 
to secure treatment for which he was referred to dispen- 
saries. In physical exterior, he appeared absolutely like 
a normal child. Measurements, indeed, showed that he 
was equal to the boy of somewhat over fifteen in standing 
height, of seventeen in sitting height, of sixteen in hand 
grip, of about fourteen and a half in weight but of only 
thirteen in vital capacity. His weight is too light for 
his height, and, in spite of his limited lung capacity, he 
is quite long-busted or brachyscelous (ponderal index 
equals 22, normal equals 23.1; statural index equals 55.7, 
normal equals 52). 

On the other hand, in intellectual development this boy 
has grown to only about eight and one-half years, while 
in motor development he ranks somewhat over ten years, 
as determined by the form-board test, and eight years and 
between ten and eleven years for the right and left hand, 
respectively, as determined by the tapping test. 

He fails on both of the Healy-Fernald construction 
puzzles (A and B) after trying for nearly two and one- 
half minutes. His memory was limited to less than five 
digits, he was unable to count backwards, to write six 
syllables from dictation, to perform the weight test, to 
give descriptive definitions, to draw the two designs pre- 
sented for ten seconds or to point out the absurdities in 



SCHOOL ORGANIZATION 361 

silly statements. He required twenty-one seconds to read 
ten words with aid in the reading selection, and was able 
to reproduce three memories. He could name only thirty- 
six words in three minutes, said that three two- and three 
one-cent stamps cost ten cents, gave the date of November 
22 as December 21, constructed three separate sentences 
instead of a single sentence with the three designated 
words, gave the months of the year as August, September, 
December and February and gave as rhymes of 'spring' 
the words 'ring,' 'king' and 'rang.' 

It is almost inconceivable that this boy, a middle-grade 
moron of the simple type, should be retained as a backward 
boy for eight years in the first two grades with the hope 
of restoring him to normality, then to be transferred to 
an elementary industrial school for 'motor-minded' boys 
(what a beautiful phrase to conjure with and behind 
which to conceal the profoundest ignorance), and finally 
to come before a bureau for vocational guidance. No 
matter how apparently impossible and inconceivable, such 
are the facts. Could there be a more tragic indictment of 
the unscientific manner in wliich the majority of public 
schools and vocational guidance bureaus are now admin- 
istered.^ Is it not evident that there can be no talk of 
vocational guidance so long as not the slightest attempt 
is made to evaluate scientifically the mental, physical and 
vocational status of many of the applicants .^ Vocational 
guidance without psychological, vocational and physical 
diagnosis for at least all abnormal cases is not merely 
dilettantish and absurd, it is impossible. Let us call this 
sort of work by its true name, vocational placement and 
not vocational guidance. Most of the modem school voca- 
tional guidance bureaus are largely misnomers: they are 
merely vocational survey and employment bureaus. But 



362 MENTAL HEALTH OF SCHOOL CHILD 

the schools of the country are going to provide genuine 
vocational guidance based upon a bedrock of scientific 
diagnosis of the individual applicant, just as soon as 
society comes to realize that the future health and pros- 
perity of the children leaving the schools for work 
depend fundamentally upon their placement in positions 
whose exactions are compatible with their general level of 
mental functioning and not incompatible with their indi- 
vidual physical weaknesses. To place children in positions 
which they cannot possibly fill is mischievous and 
reprehensible. 

Let me reinforce these conclusions by the two following 
cases. 

Case 7 

A boy, aged sixteen at the time of the examination in 
April, 1912. 

His record shows that he was the youngest of four 
children; he learned to talk at least one and one-half 
years late; pertussis and measles at three; diphtheria at 
five, which seemed to impair his power of retentiveness ; 
he showed a tendency to play by himself. 

He entered school at six, reaching the fourth grade 
after eight years ; always had difficulty, making no prog- 
ress in number work, especially in subtraction, and never 
learned to read. A good boy, but played truant because 
he did not like school, especially did not like to be in a 
class of smaller children, and dropped out entirely some 
time after being examined in the clinic. 

In the examination the eyes and tonsils were found 
defective, and he was referred to a dispensary, where 
glasses were supplied. Superficially he appeared to be 
perfectly normal in physical development. As a matter 



SCHOOL ORGANIZATION 363 

of fact, in standing height and weight, he was only a 
trifle short, measuring 15.5 in the former and nearly the 
same in the latter, while in sitting stature he measured 
less than 15, in head circumference 13, but in vital 
capacity only 12.5. In strength of grip he was about 
normal for his age, although relatively stronger with the 
left than right hand. He was slightly too light for his 
height and age and his bust was rather too short (ponderal 
index equals 22.7, normal equals 23.4; statural index 
equals 50.7, normal equals 51). 

But his significant deficiency was mental not physical. 
In intelligence he measured only nine years and in motor 
development only seven and one-half. 

He succeeded with the simpler of the Healy-Fernald 
construction puzzles (A) after 131 seconds, but failed on 
the more difficult one (B) after three and one-half 
minutes. He was able to add five and six, and seven and 
eight correctly, but unable to subtract seven from thirty- 
one, or sixteen from twenty-eight ; twenty-five cents minus 
six cents in the change test gave twenty-four cents. He 
could not define descriptively, or correctly distinguish the 
five weights, or give three monosyllabic rhymes, or repeat 
six digits, or perceive absurdities. He named the months 
as April, July, May and June, but was able to recognize 
all the coins. 

This boy was reconmiended to a special class as a case 
of high-grade defectiveness (of higher caliber than indi- 
cated by the Binet tests), complicated with alexia. Think 
of the years of wasted effort spent in trying to teach 
a word-blind, feeble-minded boy to read by ordinary 
methods ! 

On December 19, 1913, or nearly a year and eight 
months after the initial examination, the boy came to the 
clinic for the third time. By the Binet system, he now 



364 MENTAL HEALTH OF SCHOOL CHILD 

ranked 10.2 years; that iS;, he had gained 1.2 years; but 
this considerable gain is partly due to the fact that he 
passed the ten-year standard, on which he had failed the 
first time. He still failed on four of the six nine-year 
tests. He now did the change test and selected the 
weights in the order of heaviness but failed to repeat the 
days in order (Monday, Tuesday, Wednesday, Friday, 
Saturday). He gave the months as April, May, June, 
July, September, November. He was able to give the 
date and year correctly but not the month. He gave only 
forty words in three minutes but solved the absurdities 
(eleven), resistance-to-suggestion (twelve) and drawing- 
of-diamond (thirteen) problems. He did the more diffi- 
cult of the Healy-Fernald construction puzzles (B) in 
fifty-eight seconds, which he failed to solve the first time, 
and opened the Healy-Fernald instruction box without 
hesitation. He did the Vineland form-board in 3.2 
seconds less time than at first, thus measuring a little 
higher than nine years, or 1.5 years higher than the first 
time. He did not know all the letters of the alphabet, 
reading f as k, q as o, g as d, z as i, y as u and j as 1. He 
read 'to' and 'the' correctly but 'it' as 'in' and 'in' as 'is.' 
He was able to reproduce ten memories from the experi- 
menter's reading of the selection as against five the first 
time. On the physical side he had gained very consider- 
ably: two and one-half years in standing height and lung 
capacity, making him more than equal to the eighteen- 
year-old in the former and equal to the fifteen-year-old 
in the latter; he had gained over a year in sitting height 
and weight, reaching a sixteen-year development; and in 
strength of grip he had also advanced somewhat. He 
has thus become increasingly light for his height and also 
increasingly short-chested. 

It is evident that the boy has grown an appreciable 
extent both mentally and physically during the lapse of 



SCHOOL ORGANIZATION 365 

the year and eight months. Shall we say that this mental 
growth is due to the fact that he has been out of school at 
work? There is, to me, not the slightest doubt that a boy 
of this type will improve more mentally if kept busy at 
out-of-school tasks which he can do, than if confined in the 
regular classroom and compelled to labor over work for 
which he has no aptitude and which he can never compre- 
hend. There is no doubt that our unscientific systems of 
school classification, rigid methods and hyper-uniformity 
of curricular requirements have immeasurably retarded the 
mental development of innumerable exceptional children. 
However, the laboratory study and vocational record 
of this boy confirmed the earlier diagnosis of high-grade 
feeble-mindedness. During a period of less than one and 
one-half years, he has held at least six different jobs, 
retaining each only from one to three months, and receiv- 
ing in weekly pay from $5 to $9. One of these positions 
was given liim by his cousin, while his latest position was 
secured through the friendship of the employer for his 
grandfather. But his present employer reports that he 
cannot use him after January 1, 1914, because the boy 
possesses 'no independence.' He has to be 'told over and 
over again how to do a thing and then cannot do it,' he 
has 'a poor memory and can only do mechanical things.' 
So the boy will soon have to resume his perennial job- 
hunting. This is indeed the sad but universal story of 
morons, border-line cases and the very seriously backward 
children. Is it not worth while for vocational guidance 
bureaus to make a scientific appraisal of the mental level 
of vocational applicants .? Is it not worth while for the 
public schools to select these cases early in their school 
career for special treatment and then transfer them to 
colonies where they may work contentedly and effectively 



366 MENTAL HEALTH OF SCHOOL CHILD 

under supervision? — for without kind and efficient super- 
vision these children nearly always fail. At large in 
society under modern competitive conditions, they are 
almost invariably doomed to utter industrial, and fre- 
quently moral, shipwreck. Is it not an imperative obliga- 
tion on the part of society to save the large army of 
high-grade defectives from unavoidable pauperism, from 
enforced criminal careers and from the reproduction of 
their kind, by forcibly placing them in self-sustaining 
colonies.? These are fundamental social questions which 
the state and the state-supported schools cannot shirk. 
There are no more important questions in our entire social 
economy. The public schools are the great clearing- 
house, the common Ellis Island, through which all children 
must pass. The burden of selection and classification thus 
rests primarily upon the schools. 

Case 8 

My next case is a so-called defective delinquent who was 
brought to the clinic by a probation officer of the juvenile 
court, an Italian boy born in America, aged fourteen years 
eleven months at the time of the examination in May, 1912. 

He was the seventh of eight children, four of whom 
died during the first year of life; birth and development 
normal, never ill, bright as an infant. One child died in 
spasms and the youngest suffered from weak ankles and 
convulsions. The mother has developed an abdominal 
tumor. 

'Learned very little in school,' was never able to read 
much but was promoted to the fourth grade. He was 
brought by the mother before the juvenile court in May, 
1906, because of persistent incorrigibility and truancy; 
attended school about two days a week. Released on 



SCHOOL ORGANIZATION 367 

probation, but was returned after a few months because 
of truancy and vagabondage. Lived in the streets and 
rarely came home for meals, but subsisted on cakes and 
pies from the restaurants. Was committed to a boys' indus- 
trial home but was again released on probation. On 
failure to improve, he was placed in the court's detention 
home in June, 1909, for one week and was then sent home 
because he 'seemed so small.' A process issued for him 
in May, 1910, because he had played truant and loafed 
around the Pennsylvania station, was not served as the 
school principal reported that he was doing better. In 
October, 1910, he was committed to a private home away 
from the city. Here he 'improved wonderfully physically,' 
worked steadily and his conduct was good, except that he 
ran away. Was released from the home in March, 1912, 
on the mother's petition, because she was contributing 
slightly towards his support and instead wanted the boy 
to help support her. 

In May, 1912, he was brought to my clinic for exami- 
nation and was found to suffer from bad oral conditions 
(he was referred to the Dental College of the University 
where he had ten or twelve fillings made gratuitously). 
In physical development he was very much stunted, 
measuring in stature about 10.5 years, in weight between 
10.5 and 11, in sitting stature nearly 11.5, in vital capac- 
ity nearly 12 and in dynamometry 12.5 with the right 
and 12 with the left hand. His weight was about normal 
for his height but he was of the long-busted type of 
stature (ponderal index equals 23.4, normal equals 23.1 ; 
statural index equals 54.4, normal equals 52). 

His intellectual development was about on a par with 
his physical growth, somewhat less than 10.5 years. In 
motor development, he graded a little better, or 1 1 years. 

He did both of the Healy-Fernald construction puzzles 
(A in fifteen seconds and B in fifty-three seconds), and 



368 MENTAL HEALTH OF SCHOOL CHILD 

opened the combination safe in twenty-five seconds. He 
gave sixty words in three minutes but failed on the design 
and suggestion tests in ages ten and twelve. A short time 
after the clinic examination^ he was placed in a private 
special class. 

On December 9, 19 13,, a social investigator of the clinic 
found the mother in despair over the boy^ who now^ at the 
age of 16.5 years^ was constantly changing his jobs, 
staying out late at night, getting up between twelve and 
one o'clock in the daytime, spending part of his time 
loafing around the station, where he was the easy tool and 
cat's-paw of hoodlums. He was defiant of his mother, 
who now had no control over him. She says 'bad boys 
make John bad and call him scab when he work.' Still 'I 
no want him go school. He can earn money, I sick.' 

On the following day the boy was reexamined in the 
clinic. He seemed to be very glad to meet the examiner, 
was very responsive and appeared bright and intelligent. 
He reported that he had been out of the control of the 
juvenile court for nine months, that he attended an ele- 
mentary industrial school for a while but did not like the 
work because the reading, electrical and wood work were 
too hard, and because he was punished when he made a 
mistake. (Here is an unrecognized high-grade defective 
in an elementary industrial school who is punished because 
he does not do the required work, when the real fact is 
that he is feeble-minded and cannot possibly do the work. 
This reads like a chapter from the medieval inquisition.) 
He held a job for a couple of months painting vehicles at 
$6.50 per week, but quit because he cut his finger, he 
delivered flowers for a while at $4.50 per week, he carried 
messages at two cents each, yielding from $4.00 to $4.50 
per week, for the Western Union three weeks ago for two 
months (note the discrepancy), but quit because he had 
to run too much; he now sells peanuts in a theater after- 



SCHOOL ORGANIZATION 369 

noons and evenings, clearing about $2.70 per week. He 
said the street loafers hit him and called him scab. 

The psychological examination showed that the boy did 
a little better in some things than he did when examined a 
year and seven months earlier, but that in general intelli- 
gence he had gained only about .2 of a year. In motor 
development, he showed a slightly greater increase but 
was still far below normal. In physical development, he 
had improved far more, having grown about 2.5 years in 
standing and sitting stature and weight, and about 1.5 
years in lung capacity and hand squeeze. But even thus, 
he ranked in bodily development only as a child from 
thirteen to fifteen. 

Here is a so-called defective delinquent who was not 
recognized as a defective either in the schools or the 
juvenile court. As a matter of fact, this boy is primarily 
a defective and only secondarily a delinquent. He has 
never committed any serious crime, so far as I know. 
Inherently he is not vicious. But his mental deficiency 
makes him an easy dupe for evil boys and makes it almost 
impossible for him to retain a paying position. If left 
at large he will almost surely drift into pauperism and 
crime, and society will have to pay the penalty. Would it 
not be more rational and economical to classify children 
of this type early in their school careers, supply them with 
proper manu-mental training, and then graduate them into 
the state colonies where they should be compelled to live 
their lives in innocent, happy and useful service.'' 

Case 9. 

Somewhat different is the following morally unstable 
retardate, an embryonic delinquent who comes from a 
morally and socially defective home, a boy bom in Naples, 



370 MENTAL HEALTH OF SCHOOL CHILD 

aged twelve years eleven months at the time of the 
examination in October, 1913. 

He was the second of six children, born at full term, 
weighed eight pounds, nursed for fifteen months, walked 
and talked at 1.5 years; about this time experienced a 
'stoppage in speech' ; at five, fell and broke his nose, which 
since then has been bleeding almost daily so that in the 
morning his pillow is usually blood-stained. Measles, 
whooping cough, mumps and scarlet fever at seven, since 
which time he has acted 'queer.' He is gluttonous, drinks 
tea, coffee and beer and chews tobacco. Quick-tempered, 
untruthful, disobedient, cruel to brothers and sisters, lies 
and steals. When sent to the store to make purchases, he 
will appropriate the money for his own use and have the 
goods charged to his parents. He has also appropriated 
money which he has collected for his church, which he 
never attends, although he is sent there. When punished 
at home, he 'screams and yells terribly,' runs away and 
stays out all night. He has slept in a dog box and on the 
hillside, and he is never at home except for meals and to 
sleep ; he usually loafs in the woods with a gang of older 
boys. 

The home conditions are fairly good financially, 
although the mother makes repeated trips to the Asso- 
ciated Charities whenever a child is to be born. She is 
probably immoral, wishes to get rid of her children, is very 
lazy, fails to prepare the meals properly and leaves her 
new house of five rooms in a filthy, unventilated, dis- 
ordered condition. The house contains nine lodgers, 
exclusive of two dogs, three cats and a goat. The cats 
have been seen to walk on the table at meal-time and help 
themselves from the dishes. The whole family will sleep 
in the same bed, although other beds have been given to 
them by the Associated Charities. The home life is tem- 
pestuous and degrading. The child is poorly disciplined, 



SCHOOL ORGANIZATION 371 

whipped, abused and called 'crazy' by the father. The 
father also abuses his wife. The parents are intemperate, 
but the family history is negative, except that the mother's 
father was rheumatic. 

The boy has been in school fifty-three months and has 
reached the fourth grade. He has spent two years each 
in the first and second grades. His poorest work is in 
reading (he reads in fourth reader), memorizing and 
spelling, and his best work is in music, manual training, 
drawing and abstract work. He cannot do the fundamental 
arithmetical processes. He has good powers of observa- 
tion and concentration. Some teachers say that he is one 
of the best-behaved and others that he is the worst- 
behaved pupil in the school. He apparently has a dual 
nature : at times interested, willing, obedient and cheerful ; 
at other times cranky, obstinate, sullen, devilish and 
resentful of reproof, threatening to kill someone when 
angry. Also has a 'dual walk,' at times he stamps his 
feet, at other times he walks normally (but his gait is 
poor). After his mother had reported his incorrigibility 
to the school authorities, he changed for the worst and 
tried to live up to his reputation ; but punishment in school 
resulted in improvement. His teacher says he has been 
well-behaved for the past nine months. 

The clinic examination showed that the child was 
suffering from a slight degree of astigmatic myopia, two 
dental caries, enlarged tonsils, enlarged adenoid growth, 
enlarged left turbinate and deviating septum (he was 
referred to a dispensary for treatment but nothing has 
been done because of parental objections). He was 
retarded in both physical and mental development, in hand 
grip measuring about 12 years, in vital capacity 11, in 
weight 10.5, in standing and sitting stature a little over 
9.5, and in head girth 6. His ponderal index was a little 
better than normal (23.8 vs. 23.1), while his statural 



372 MENTAL HEALTH OF SCHOOL CHILD 

proportions indicate that he is a little brachyscelous (53.8 
vs. 53). 

In motor development, he grades between nine and ten 
and in intelligence ten (although he passed two of the 
thirteen-year tests). 

He passed all of the tests in age nine, two in ten 
(months and money), one in twelve (three rhymes) and 
two in thirteen (diamond and reversed triangle tests). 

Here is a boy who is just as genuinely deficient as a 
feeble-minded boy but to a lesser extent. The difference 
is one of degree. His is a case of pronounced instability of 
disposition superposed on a background of pronounced 
backwardness, aided and abetted by a demoralizing home 
environment. The orthogenic treatment indicated here 
is not merely surgical attention and corrective pedagogic 
treatment in a special class, preferably in a parental 
school, but the reconstruction of the social and moral con- 
ditions in the home. Eventually the schools will have their 
educational laboratories and clinics with a staff of social 
workers who wiU study the social influences of the home and 
street which predestinate many children to deficiency or 
delinquency. And eventually the state will take steps to 
forcibly reconstruct the home whenever it tends to debauch 
childhood, or the children will be removed from the homes 
and placed in institutions. 

I turn now to three types of supernormal children. The 
need of scientifically classifying supernormal pupils is 
even more urgent and the value to be derived from their 
efficient pedagogical training is even greater than the 
classification and special treatment of subnormal children. 

Case 10 
An American girl of English-Scotch ancestry, aged 



SCHOOL ORGANIZATION 373 

eight years four months at the time of the examination in 
August, 1912. 

An only child who developed normally save for delayed 
dentition (teething began at two). Typhoid-pneumonia 
at three and one-half, attended by loss of consciousness, 
and by severe intermittent convulsions for three days. 
Convulsions recurred once six months later. Measles at 
four. For five years affected by convulsive tics of the 
shoulders and arms, which, however, had shown improve- 
ment five weeks prior to examination. Sleep restless and 
disturbed by dreams; loses temper constantly; takes cold 
easily. 

The home conditions are good. Father decidedly rest- 
less from childhood; subject to impulsive tics, picks up 
objects repeatedly, is intense in action. Mother's father 
is alive at seventy-eight, but subject to convulsions about 
once a week, said to be brought on by excitement. 
Mother's mother died at seventy of nervous prostration, 
father's father accidentally killed at forty-seven; father's 
mother died at fifty-nine of chronic inflammation of the 
bowels. 

This girl had been in school twenty-three months and 
was seven months advanced in her work (IV B instead of 
III B) ; is good in all branches, especially in reading, 
spelling and telling stories. Worst faults, restlessness 
and quick temper. 

At the time of the clinic examination, she was subject 
to tics of the arms and nervous starts affecting the whole 
body. The roots of eight deciduous teeth were in very 
bad condition (she was referred to the Dental College for 
expert examination and treatment). In physical develop- 
ment she was about normal, rating about 9 in hand grip 
for the right hand and 8 for the left hand, 9 in standing 
stature, 8.5 in sitting stature and vital capacity, and about 
8 in weight. But she is too light for her weight and is 



374 MENTAL HEALTH OF SCHOOL CHILD 

somewhat short-chested (ponderal index equals 22.4 
instead of 23.8; statural index equals 54 instead of 55). 
In intelligence she grades twelve years, or 3.5 acceler- 
ated, passing all the tests in age ten and all except one 
each in ages nine (making change), eleven (absurdities) 
and twelve (problems). 

This is a beautiful illustration of distinct youthful pre- 
cocity resting upon a pathological background. Judging 
from the standpoint of intellectual maturity, this girl was 
marking time in the schools. She should have been 
advanced at least two years instead of seven months. 
However, this girl cannot be classified purely according to 
her degree of intelligence. She distinctly belongs to the 
neuropathic type of supemormals, and requires a most 
discriminating educational and hygienic regimen. Unless 
this fact is recognized and appropriate treatment is 
accorded her in the schools, the schools certainly will be 
guilty of contributory negligence in furthering the 
development of possible adult instabilities in this child. 
Many adult neuropaths and psychopaths have been manu- 
factured by the unscientific and indiscriminating treatment 
which mentally abnormal children have received in the 
home and school. 

Case 11 

My next case is also a nervously, although non-patho- 
logically, precocious child, an American girl, aged nine 
years four months at the time of the examination in 
March, 1913. 

She is the oldest of three children, with a record of 
normal birth and normal development; scarlet fever at 
four years and three months, pertussis and measles at six ; 
is nervous, sleepless, easily fatigued, suffers from frontal 



SCHOOL ORGANIZATION 375 

headache^ subject to fears, afraid to go to her room in the 
dark. Operated at six for adenoids and enlarged tonsils. 
One feeble-minded aunt and an epileptic relative. 

She was advanced in her school work, being in the 
fourth grade after twenty-seven months of schooling. She 
was good in all branches, but best in reading, drawing and 
music. 

In the clinic she was nervous and fidgety. Her tonsils 
were found to be considerably enlarged and infected. In 
physical growth, she was distinctly superior to the 
average, measuring fully 12 years in strength of grip 
and sitting height, 11.5 in weight, 11 in standing height 
and 10 years in vital capacity. She is long-busted, but her 
weight is about normal for her height (ponderal index 
equals 23.6, normal equals 23.5 ; statural index equals 
55.9, normal equals 55). 

In intelligence, she graded 11.8 years but in motor 
development only 10 years. In the tapping test she 
graded a little less, but she solved (in two minutes) the 
construction puzzle (B) which requires intelligent adap- 
tation. She passed all the tests in ages nine and ten, all 
except the association test in eleven, two tests in twelve 
(rhymes and memory for sentences), and the diamond 
test in thirteen. 

Intellectually this girl had the capacity to do work one 
or two years in advance of her school classification, and 
there is no reason why she should not be permitted to work 
at an accelerated pace, provided she is kept in good 
physical condition and provided the pressure is relaxed 
somewhat during her periods of accelerated physical 
growth. 

On the advice of the clinic, the father, a school princi- 
pal, immediately had her tonsils dissected, and during the 
months of July and August he kept her on a farm in the 



376 MENTAL HEALTH OF SCHOOL CHILD 

country where she received plenty of wholesome food, fresh 
air and out-of-door exercise. As a result, the girl returned 
at the beginning of the present school year in excellent 
condition physically and mentally. The nervous symptoms 
had disappeared and she now ranks first in her class. It 
is uneconomical of public funds and wasteful of human 
brain power to keep children eight years in the grades who 
can finish the course just as well in six years. 

Case 12 

This conclusion will be further enforced by the con- 
sideration of my final case, a healthy type of supernormal 
child, a girl aged five years seven months at the time of 
the examination in August, 1912. 

She was the second of three children^ weighing ten 
pounds at birth, walked in the fourteenth month, used 
words in the twelfth and sentences in the sixteenth and 
had ten teeth in the tenth month. Chicken pox and severe 
stomach trouble in her third year. 

Mother's mother got overheated and died of inflamma- 
tion of the brain at forty-four (during climacteric), a 
paternal aunt suffered from tuberculosis, and neuras- 
thenia, developing into a type of insane dementia, from 
which she died at thirty-six. 

Home conditions excellent; she is good in handwork, 
can clear table, iron plain clothes and do construction 
work with building blocks. 

At the clinic, her muscular coordination was good, her 
eyes were good in respect to binocular coordination and 
distance and light accommodation, but her nasopharynx 
was slightly congested and she was somewhat flat-footed. 

In physical growth, she was distinctly superior to the 
average, equaling 9.5 years in dynamometry, 7 years in 
standing height and weight and 6.5 in sitting height. 



SCHOOL ORGANIZATION 377 

Her physical superiority was paralleled by her mental 
superiority. In intelligence and motor development, she 
graded about 7.5 years. 

She passed all the tests in age six, five in seven (she 
could not write from copy, describe pictures or recognize 
a twenty-five cent piece), three in eight (passing the 
stamp, color and statement-of-difFerence tests), one in 
nine (repetition of week days) and none in ten. She 
failed on the construction puzzle (B) after seventy-five 
seconds. 

There are hundreds of healthy, gifted children such as 
this girl in every community of any size who would be 
able to finish the eight elementary grades in six years or 
less if they were only afforded the opportunities by the 
schools, and they would do so with distinction and without 
in the least imperilling either their physical or mental well- 
being, provided, of course, due checks were kept on their 
temporary health deviations and growth accelerations. 

The conservation of the mental health of school children 
demands not only that we shall select, classify and provide 
specialized training for cliildren of inferior ability, but 
(even more insistently) that we differentiate children of 
superior attainments and organize for their benefit systems 
of flexible grading, special supernormal or special oppor- 
tunity classes, and differentiated pedagogic treatment. 
Surely the conservation and promotion of the mental 
health of gifted children, who are destined to become the 
leaders of social progress, is even more important than 
providing special opportunities for defectives. One 
inventive genius is worth more to society than a hundred 
drones. It is the mission of the schools to foster and not 
to suppress genius. The school systems of the past, with 
their emphasis on uniformity, on the essential likeness of 



378 MENTAL HEALTH OF SCHOOL CHILD 

children, on equivalence of pedagogical treatment and on 
mass results, have tended to develop sameness, subservience 
and mediocrity. The school systems of the future, with 
their emphasis on diversity, on the essential difference of 
children, on differentiated pedagogical treatment and on 
individual results, will foster individuality, independence 
and genius. The ideal of the past was : a uniform pro- 
gram of work and a uniform rate of progress for all the 
pupils. The slogan of the future will be: expert educa- 
tional diagnosis as a basis for differentiated programs of 
work to be given at differentiated rates of speed to meet 
the needs of all kinds and classes of pupils. Education, 
I repeat, is fundamentally a process of adjustment, and 
only so far as the schools succeed in adjusting the educative 
processes to meet the needs of the individual pupil will 
they conserve the mental health interests of children. 

The conclitsions at which we have arrived may be sum- 
marized as follows : 

1. It is impossible scientifically or effectively to 
organize instruction in any large school system without 
segregating or grouping together pupils who are measur- 
ably similar either in respect to mental normality or mental 
abnormality. The instruction of palpably abnormal with 
normal children is an injustice to both the abnormal and 
normal pupils, and to the teacher, and can only be 
regarded as a survival of pedagogic barbarism. 

2. It is impossible efficiently to group together or to 
teach children who depart from the standard of mental 
normality without a prior scientific diagnosis of each case. 

3. So far as concerns the differentiation of mentally 
unusual children, the work of diagnosis requires the 
services of a technically trained and experienced psycho- 



SCHOOL ORGANIZATION 379 

educational examiner, and not a school nurse, teacher, 
principal or medical inspector. It is absurd to suppose 
that an amateur is qualified to perform the extremely diffi- 
cult work of mental diagnosis. 

4. Every large school system should maintain as an 
essential part of its administrative organization, an edu- 
cational clinic and laboratory for the study and differ- 
entiation of the numerous types of deviating children who 
must receive instruction in the schools, who will apply for 
vocational guidance and who prospectively or actually 
come before the juvenile court. The schools themselves 
should adequately diagnose children before they are recom- 
mended to the employer or before they come before the 
juvenile court. 

In large cities the clinic should be established as an 
independent department of the schools — or as a division 
of the department of special education. It should be 
closely affiliated with the training school for teachers and 
with the department of medical inspection. The staff 
should consist of the following: (1) One director of the 
psycho-educational chnic and the department of special 
education, in executive charge of the department and 
directly responsible to the superintendent of schools. 
(2) One supervisor of special education, directly respon- 
sible to the director of the department. (3) One or more 
social workers. Teachers or school nurses may be used, 
provided they have received a certain amount of special 
training for the work. (4) One or more mental testers for 
some of the routine testing. Adaptable grade teachers 
may be trained for this work. (5) One medical man, to 
serve as a 'clearing house,' or general utility man on the 
medical side. (6) One or more clerks for stenographic, 
record, tabulation and computation work. Under this 



380 MENTAL HEALTH OF SCHOOL CHILD 

scheme of organization the director of the chnic will have 
authority over the special classes, and will make the 
influence of the clinical work felt in the training of 
teachers. 

5. The differentiation and specialized training of 
children who depart from the average standard of men- 
tality will ultimately prove an economic gain to the 
community and a boon to the individual pupils ; the con- 
servation of the nation's brain power demands such 
differentiation early in the school career of the child. 

6. The authority of the schools must be so extended 
as to include control of the child's out-of-school environ- 
ment when this is demoralizing to the mental, physical or 
moral health of the child, thereby rendering the work of 
the schools nugatory ; and also so as to include the right by 
statute to graduate or transfer anti-social types of chil- 
dren into custodial and industrial colonies where they may 
spend their lives as harmless, productive servants and 
wards of the state. 

7. Finally, a word in regard to the situation in Penn- 
sylvania. The effort to scientifically differentiate and 
classify exceptional children educationally may be said to 
have originated in Pennsylvania. Both of the Pennsyl- 
vania universities now maintain free clinics for the 
psycho-educational diagnosis of children. There is prob- 
ably no state in the union that offers superior university 
facilities for rendering this type of philanthropic service 
to the community. But the public schools in Pennsylvania 
have, in the large, failed to do their duty in the establish- 
ment of special classes and special forms of instruction for 
educational deviates. I make this statement after a care- 
ful canvass of the replies made to a questionnaire which 
was sent last October to over 1,350 school systems 



SCHOOL ORGANIZATION 381 

throughout the country (unfortunately even some of the 
larger systems in Pennsylvania have made no reply). 
Space does not permit me to give the detailed results of 
this inquiry. But let me point out two facts. 

First, in regard to the character of the work being 
accomplished in a state which has rapidly assumed a posi- 
tion of leadership in the enactment of constructive educa- 
tional legislation, namely, New Jersey. State school laws, 
enacted in 1911 and 1912, now make it compulsory for 
every local school board in New Jersey to ascertain the 
number of subnormal ('three years or more below the 
normal'), blind and deaf children in the schools, and to 
establish special classes for the training of these types of 
cliildren whenever ten children of each type are found in 
any school district (provided the blind or deaf are not 
or cannot be cared for in an institution). No class may 
contain more than fifteen pupils, and for each teacher 
employed in one of the special classes the state appro- 
priates $500. Under these laws 102 classes for subnormal 
children, with an enrollment of about 1,400, had been 
established up to November 24, 1913 (according to infor- 
mation received from G. A. Mirick, Assistant Commissioner 
of Education), and practically all of the large cities have 
established psychological clinics or their equivalent, or 
utilize university clinics. When may we hope to have 
similar laws enacted in Pennsylvania? With similar laws 
on the statute books Pennsylvania would now have from 
500 to 1,000 special classes for backward and feeble- 
minded children alone. Is ft not a legitimate function of 
this Association to urge upon the legislature the enact- 
ment of laws for the compulsory segregation of seriously 
backward and feeble-minded children in special classes in 
the public schools? 



382 MENTAL HEALTH OF SCHOOL CHILD 

Second, in regard to the recent marvelous increase of 
the psychological clinics. According to questionnaire 
replies which have arrived to date we now have the fol- 
lowing number of psychological clinics in the United 
States, more or less expertly manned: nineteen in public 
schools ; sixteen in university schools of education and 
departments of psychology ; seven in medical schools ; 
three in normal schools ; five in public and private institu- 
tions for the feeble-minded; six in penal and correctional 
institutions; two in juvenile courts; and five in hospitals 
for the mentally disordered ; or a total of sixty-three. This 
does not include scores of pubhc schools, institutions and 
courts in wliich a few formal psychological tests (particu- 
larly the Binet) are given by teachers or medical 
inspectors. I may add that fifteen school systems (exclu- 
sive of suburban schools located near clinics) are utilizing, 
to some extent, university of privately supported psycho- 
logical clinics, so that about thirty-five large school 
systems now attempt more or less systematically to 
psychologically and educationally diagnose unusual chil- 
dren. 

To conclude: the schools must forever renounce the 
rigidly inflexible curricula of the past, which have proved 
veritable pontes asinorum to hundreds of thousands of chil- 
dren who do not conform to the assumed typical or normal 
child, and provide, instead, remedial, corrective or differ- 
ential instruction designed to meet the varying needs of 
all types of talent and of all types of educational 
abnormality or deviation. 

Some one has said : 'the sum of our failures in education 
is measured by the number of our failures with individuals.' 
I would add: there cannot be efficient school organization 
or effective instruction without individual diagnosis. 



CHAPTER XVIII 

PUBLIC SCHOOL PROVISIONS FOR MENTALLY 
UNUSUAL CHILDREN 

On October 29, 1913, a questionnaire on public school 
provisions for mentally exceptional children was sent to 
the superintendents of public schools in all the cities of the 
United States of America having a population of 4,000 
and over. On December 12 copies of the same question- 
naire were again sent to a considerable number of super- 
intendents in the larger cities of the country who had not 
replied to the earlier letter. In some cases as many as 
three or four inquiries were sent before any response was 
forthcoming. As a result of these repeated inquiries, 
replies were received from all the cities of the country with 
a population of 100,000 and over (50 cities), from 53 
per cent of the cities of 25,000 up to 100,000 (96 out of 
179 cities), and from 156 with a population of less than 
25,000. In all, replies were received from 302 cities, or 
somewhat less than one-fourth of the number addressed 
(about 1,350).^ 

Special classes of some kind are supported by all of the 
cities of 100,000 and over, except Scranton, Pa. ; by 65, 
or somewhat less than 68 per cent, of the 96 cities of 
25,000 up to 100,000 ; and by 57, or somewhat less than 
37 per cent, of the 156 cities of less than 25,000. It is 

1 My thanks are due to the superintendents or their subordinates 
who took pains to answer the questionnaire; without their kindly 
interest this study would have been impossible. 



384 MENTAL HEALTH OF SCHOOL CHILD 

probably safe to conclude that the majority of the cities 
which failed to report do not maintain any of the special 
classes enumerated in the questionnaire: namely, 'classes 
for the feeble-minded and seriously backward, ungraded 
classes for giving individual attention merely to pupils 
retarded in various subjects, epileptic, speech-defective, 
disciplinary or truant, bright, blind, deaf, etc' 

The value of the replies varied considerably. Some 
were prepared with singular regard for accuracy and com- 
pleteness, at great expense of time and labor. Some re- 
spondents answered certain questions very completely, but 
others very incompletely or not at all. Others gave rather 
incomplete data on all questions, or occasional ambiguous 
answers, with the result that it was sometimes difficult to 
determine whether the classes reported should be tabulated 
as 'special classes for the feeble-minded or seriously back- 
ward,' or as 'ungraded classes for giving individual atten- 
tion merely to pupils retarded in various subjects,' or 
whether the psycho-educational examinations were made 
by teachers, principals, physicians or psychologists. A few 
superintendents merely sent copies of their annual reports. 
Unfortunately, these seldom gave all the information con- 
templated by the inquii-y. It is a serious handicap that we 
do not have a central federal Educational Bureau in the 
United States, legally vested with the power of exacting 
reports on all phases of education from all the schools of 
all the states. It never has been possible, and probably 
never will be, through private inquiry to secure replies 
from all the public and private schools of the country. 
However, the replies received to this inquiry are suffi- 
ciently numerous to afford a considerable fund of new data, 
as well as a solid basis for drawing important deductions, 
particularly as respects the type of classes in which we 



PUBLIC SCHOOL PROVISIONS 385 

are here specially interested and to a discussion of which 
most of this chapter will be devoted, namely the classes for 
the feeble-minded and seriously backward. 

Special Classes for the Feehle-Minded and Seriously 
Backward 

From an inquiry made by the United States Commis- 
sioner of Education in March, 1911, it appeared that out 
of 898 cities reporting, 99 supported classes 'for the 
mentally defective' (including classes for epileptics), and 
220 had classes for 'backward children' (see Bulletin No. 
461), or a total of 319. The latter classes include 
instances in which 'special teachers are employed to assist 
slow pupils.' My returns indicate that 108 cities maintain 
special classes for the feeble-minded and seriously back- 
w^ard ( although it is probable that some of these classes are 
not conducted strictly as special classes), and 111 cities 
have ungraded classes for the retarded, or a total of 219. 
Since my figures are based on about one-third as many 
answers as the Bureau's survey, but show 68 per cent as 
many classes, it is very probable that there has been a 
material increase in the number of cities supporting special 
and ungraded classes. However, the data may not be 
strictly comparable, owing to the difference in the termin- 
ology employed in the two inquiries. The Bureau made a 
survey of (1) classes for 'defectives' and (2) classes for 
'backward children,' while I collected data on (1) special 
classes for the 'feeble-minded and seriously backward' and 
(2) 'ungraded classes for giving individual attention 
merely to pupils retarded in various subjects.' It is quite 
probable that many classes recorded as 'special' in the 
Bureau's report did not provide a special curriculum of 



386 MENTAL HEALTH OF SCHOOL CHILD 

manual work, and would therefore be registered as un- 
graded classes in this study. 

The term 'defectives' is objectionable, because it carries 
no fixed connotation. Usually when applied to school cases 
it is restricted to children who are obviously feeble-minded. 
But there is no scientific warrant for thus restricting its 
application, because pupils who are seriously backward are 
just as truly deficient or defective as the border-line or 
feeble-minded cases, but only less so. Fundamentally, the 
difference is quantitative rather than qualitative. Again, 
the practice of referring to special classes for 'defectives' 
is pernicious because it creates the mistaken idea that these 
classes are intended only for those who are actually feeble- 
minded; indeed, the first public school special classes 
(those started in Germany) were organized solely for the 
feeble-minded. This idea has become almost universally 
and ineradicably intrenched in the habit of thought of the 
average schoolman. The special class for defectives or 
deficients always means to him the class for the feeble- 
minded. But the special classes in the public schools 
should receive not only the imbeciles and morons, but also 
the border-line and seriously backward cases. The seri- 
ously backward children should be given the same kind of 
manumental and industrial program (with modifications, 
to be sure, to meet the needs of each case) that is provided 
for the morons. Negatively, they should not be consigned 
to the ungraded classes, as is now the custom, where they 
are only given individual attention and coaching in the 
usual academic subject-matter. What the seriously back- 
ward child needs is a different kind of subject-matter and 
not increased drill on the same contents. 

The study of my returns has emphasized again and 
again the great necessity of clearly distinguishing between 



PUBLIC SCHOOL PROVISIONS 387 

the functions of various kinds of special classes for im- 
beciles, morons, border-cases, seriously backward, back- 
ward and retarded children. It is particularly important 
sharply to distinguish between the so-called 'special' and 
'ung-raded' classes. The followino; recommendations are 
therefore offered in the interest of consistency: 

First. Special classes in which imbeciles, morons, border- 
line and seriously backward cases are taught should be 
designated 'special classes,' or, better still, 'orthogenic' or 
'orthophrenic classes,' because the word special is generic and 
applies to eight or ten different kinds of special classes ; but 
only provided such classes furnish a special curriculum of 
manumental and industrial work. 

Second. The term 'ungraded classes' should be applied to 
classes in which children who are retarded in one or more 
branches are given individual attention, singly or in small 
groups or in separate classes in the branches in which they 
are deficient. These are essentially coaching classes, giving 
intensive attention to the contents of the regular curriculum. 
No child should be assigned to these classes who is considerably 
deficient in all-round intellectual capacity. 

Third. 'Elementary industrial classes' should be provided 
for young adolescents (say, from twelve or thirteen to about 
sixteen years of age) who are appreciably backward or who 
are over age because of inability to cope with the regular 
curriculum, and who withal are industrially inclined. In these 
classes the minimum of academic work provided should be 
closely correlated with the manual and industrial work. Those 
pupils in the special classes who meet the requirements should 
be graduated into these classes on reaching the age of twelve 
or thirteen. 

No school system of any size can adequately care for 
the different types of children on the minus side of the 



388 MENTAL HEALTH OF SCHOOL CHILD 

curve of mental and pedagogical distribution without 
organizing the above three types of classes. 

That the public schools of the country have merely made 
a good start in the organization of work in this important 
field of special education may be inferred from the follow- 
ing percentages of cities which thus far do not support a 
single special class for feeble-minded and seriously back- 
ward children: 16 per cent (or 8) of the cities above 
100,000 in population (Kansas City, Mo., St. Paul, 
Atlanta, Syracuse, Memphis, Scranton, Omaha, Lowell) ; 
60 per cent (or 57) of the 96 cities reporting with a popu- 
lation ranging from 25,000 to (but not including) 
100,000 ; and 83 per cent (or 130) of the 156 cities of less 
than 25,000. Certainly every city with a school popula- 
tion of 2,000 should have at least one special class. Not 
only so ; in the cities in which special classes have been 
organized the provisions are wholly inadequate. Thus 
Baltimore, New Orleans, Pittsburgh and San Francisco 
support only one special class each ; Los Angeles, Spokane 
and Denver only two; Cambridge, Richmond and New 
Haven only three ; Milwaukee and Minneapolis only four. 
Even New York's 180 classes care for only .38 per cent of 
the elementary school population, or only about one-third 
of the pupils in that city who should be trained in special 
classes. Rochester's twenty-nine classes are said to furnish 
accommodations for only about 15 per cent of the sub- 
normal children of that city. Some of these cases, how- 
ever, probably belong rather to ungraded and elementary 
industrial classes. No city anywhere in the country makes 
anything like adequate provisions for the segregation of 
feeble-minded and seriously backward children. Relatively 
to size, Montclair, N. J., with eight classes, makes the best 
provision of any city in the country, but in New Jersey 



PUBLIC SCHOOL PROVISIONS 389 

every school district having ten pupils retarded three 
years or more must, under the state law, segregate them in 
special classes (see p. 381). 

The first city to organize special classes was Providence 
(1896), followed by Springfield, Mass. (1897), Chicago 
(1898), Boston (1899), New York (1900), Philadelphia 
(1901), Los Angeles (1902), Detroit and Elgin (1903), 
Trenton (1905) and Washington, Bridgeport, Newton 
and Rochester (1906). The New York class, which was 
started about 1874, and the Cleveland class, started in 
1879, were for disciplinary or truant pupils. Although 
these classes undoubtedly contained seriously backward or 
feeble-minded children, it is not apparent that the program 
of studies consisted of special class work. 

The enrollment is limited to 15 pupils per class in forty- 
two cities, 20 in nine, 12 in six, 10 in three, 15 or less in 
sixty-seven and 20 or less in ninety-two cities. In only 
five cities is the enrollment permitted to exceed 20. In 
some cities the permissible register is very elastic, varying 
from 7 to 20, 5 to 12, 8 to 15, 20 to 30 and 18 to 24 (see 
Table II). The general tendency thus appears to be to 
limit the class register to about 15 — the limit fixed by state 
law in New Jersey. 

In order to meet the demands of instructional efficiency, 
no special class should ever contain more than fifteen 
imbeciles or morons, or twenty seriously backward cases. 
The chief objection urged to thus limiting the enrollment 
is the considerable expense required to provide equipment 
and expert instruction at advanced salaries for children 
who, as a class, can achieve only mediocre or indifferent 
success. It is argued that our chief obligation is to the 
normal, precocious or merely slightly retarded children, 
who may be trained to responsible socio-industrial service. 



390 MENTAL HEALTH OF SCHOOL CHILD 

constructive achievement and leadership. While this 
objection is well founded, it should not be forgotten that 
one of the potent reasons for segregating the subnormals 
is to free the regular grades of driftwood and dead weights. 
When we provide special opportunities in segregated 
classes to the subnormals we at the same time improve the 
working conditions for the normals. However, it is better 
to permit a register of twenty or twenty-five than to 
dispense entirely with the special classes and permit the 
ne'er-do-wells to encumber or demoralize the regular 
grades. In the regular grades these children are almost 
always irritated, disheartened, depressed or embittered by 
the progress and not infrequently jibes, jeers and ridicule 
of the normal pupils. Here they soon lapse into indifference 
or become chronic rebels. They tend to rebel against the 
tension of the normal pace, against the attempts to force 
them to apply themselves to subject-matter which to them 
is a meaningless jargon and against the seeming neglect 
or harshness of teachers who frequently fail to understand 
them and who, at best, are precluded in the regular grades 
from giving them the attention which they require. Be- 
cause of their indolence, eccentricities, abnormalities and 
not infrequent vicious, depraved or immoral practices, they 
often exert an injurious influence upon the normal children. 
Even when good-natured, virtuous and kindly disposed, 
they frequently become the innocent dupes and cat's-paws 
of their wiser but designing fellows. Hence they should be 
removed from the regular grades, not only for their own 
welfare, but for the sake of the normal pupils. 

In Germany, the general, although not the invariable, 
practice is to establish in congested centers special schools 
('Hilfsschule') instead of special classes. In London, the 
practice is to establish centers ('special school centers') 



PUBLIC SCHOOL PROVISIONS 391 

with two or three rooms in small buildings located in a 
corner of the school yard and separated from the regular 
building by a high fence. In America, the prevailing 
tendency is to organize separate classes in the regular 
grade buildings rather than separate schools. From 
Table II it is not possible to infer the exact type of organi- 
zation in effect in each city. Apparently Dayton, Wash- 
ington, St. Louis and Salt Lake City maintain 'schools,' 
although the schools are probably not all housed in sepa- 
rate buildings. The objections to segregating the chil- 
dren in detached buildings are: the grouping of many 
abnormal children throws their idiosyncrasies and abnor- 
malities into conspicuous relief; it makes the children feel 
that they are a group set aside from normal children and 
that they are essentially different or inferior; parents 
object to placing the children apart because they feel that 
it stigmatizes them ; the pupils have no occasion to mingle 
with the normal children on the playground, or to partake 
in the general exercises, hence they are robbed of the 
opportunities to learn imitatively by association with their 
normal fellows ; and many children must travel long dis- 
tances or be transported to the school at considerable 
expense. The advantages of organizing schools rather 
than single classes are : it allows of a closer grading of the 
pupils, and of grouping them according to their level of 
intelligence ; this obviates the necessity of having all 
grades of defectives associate together ; it makes possible 
group instruction, and this makes for economy, as each 
teacher will be able to instruct a larger number of pupils ; 
the central school permits of the introduction of depart- 
mental work, enabling the teachers to restrict their instruc- 
tion to their specialties, which makes for increased instruc- 
tional efficiency ; the organization of schools will probably 



392 MENTAL HEALTH OF SCHOOL CHILD 

insure a better equipment of didactic materials, as the 
industrial, manual training, kindergarten and other rooms 
can be used in rotation by the different classes. 

The best plan probably is to establish centers of three 
or four rooms in the regular buildings in congested sections 
and separate rooms in the regular grade buildings in the 
less populous districts. Moreover, the larger cities may 
very well consider the advisabihty of establishing a farm 
residential institution near the city limits for the industrial 
training of educable feeble-minded indigent children. The 
majority of these children after finisliing their course of 
training should be transferred at the age of, say, fifteen 
or sixteen years to state colonies, where they should be 
obliged to utilize in self-supporting occupations the skill 
wliich they have developed. The city residential institu- 
tion should prepare them for efficient service in colony life. 

The Examination of F eehle-Minded and Backward 
Children 

The practice of requiring some kind of special examina- 
tion before a child may be assigned to a special class is 
becoming well-nigh universal. The 103 cities in Table HI 
so reported except Elgin, Washington, Pa., Columbus 
and New Orleans ; the latter two, however, give the exami- 
nation after admission. The following cities failed to 
answer this question: Pittsburgh, Bridgeport, Fall River, 
Portland, Worcester, Aurora, Ft. Wayne and Stonington, 
Conn. It is, of course, impossible to state how thorough 
or valuable these admission examinations are. 

Eighty-one of the cities provide a medical examination, 
two do not, while twenty-one failed to answer the question 
(see Table III). 



PUBLIC SCHOOL PROVISIONS 393 

Fifty-nine (or 57 per cent) of the schools give educa- 
tional tests, while the other forty-four leave this question 
unanswered. It is impossible from the data to determine 
the character of the educational examination, but it is 
improbable that any standardized pedagogical efficiency 
tests have been used to any extent. The tests given are 
probably only the ordinary examination questions of the 
schools, or the school record of the cliild. 

That the psychological study of candidates for special 
classes is rapidly becoming universal is apparent from an 
examination of Table III. Eighty-four (or 81 per cent) 
of the 103 cities report that psychological tests are given 
either by employees of the school boards or by outside 
agencies. This includes all of the 19 cities of 250,000 
population and over, all the cities except 5 (or 76 per 
cent) of the 21 with a population of 100,000 to 250,000 
(including Indianapolis), all except 12 (or 68 per cent) 
of the 38 cities between 25,000 and 100,000 (Aurora, how- 
ever, brings some cliildren to Chicago for examination), 
and all except 2 (or 92 per cent) of the 25 cities of less 
than 25,000. Psychological testing is thus relatively more 
prevalent in the groups of cities having the largest and 
smallest populations. The names of the cities which do or 
do not conduct psychological testing may be obtained from 
the table. 

While this is an extremely creditable showing, particu- 
larly in view of what it portends for the future, it is neces- 
sary to emphasize that the psychological testing in most of 
the cities is exceedingly meager and crude, being conducted 
by teachers, principals, educators, psychologists and 
physicians who are not specialists on the physiology, 
psychology and pedagogy of feeble-minded, backward or 
other types of mentally abnormal children. This fact is 



394 MENTAL HEALTH OF SCHOOL CHILD 

revealed by an examination of the columns in the table 
giving the extent of the psychological examination, and 
the extent of the technical preparation and professional 
affiliation of the psychological examiners. (The answers 
supplied to' these questions were in many cases extremely 
ambiguous, evasive or unsatisfactory.) Fifty-two cities 
report that the testing is confined entirely, or almost 
entirely, to the Binet tests. Twenty-four respondents 
failed to answer the question. It is entirely probable, I 
believe, that at least seventy-five (or 72 per cent) of the 
103 cities do not go beyond the Binet and form-board 
tests. In some cities, less than this is attempted. In only 
twenty-one cities is it safe to infer that the psychological 
testing exceeds this minimum. Of the seven cities of 
less than 100,000 which report giving additional tests, it 
is probable that only two or three attempt anything 
approaching an exhaustive examination. 

But more important than the extent of the formal 
testing is the adequacy of the preparation and the experi- 
ence of the psychological examiners. Immeasurably more 
important than the tests is the 'man behind the gun.' An 
analysis of the table with respect to the professional affili- 
ations and attainments of the examiners, including those 
employed both by the schools and by outside agencies — a 
total of 115 examiners — shows that 52 are special class 
teachers, 11 supervisors of special classes or principals, 4 
superintendents of schools, 5 alienists or neurologists, 22 
medical inspectors or physicians, 8 psychologists and 13 
clinical psychologists (restricting the application of the 
latter term to those only who are trained experts on the 
psychology and pedagogy of mentally unusual children). 
It should be said that when the examinations were reported 
to be made by the medical inspector, special teacher and 



PUBLIC SCHOOL PROVISIONS 395 

principal, each was separately counted in the above sum- 
mary, although it is possible that in many of these 
reported instances only the special teacher made the 
psychological examination. 

These data point to various interesting conclusions : 

1. In the vast majority of cases the psychological 
testing (and possibly also the diagnoses) of mentally 
exceptional cliildren in the schools is made by Binet 
testers — in other words, by amateurs. This includes all 
the special teachers and the majority of the supervisors, 
superintendents and medical inspectors. After a careful 
scrutiny of the qualifications of the examiners, I am forced 
to the conclusion that not more than tliirty psychologists, 
physicians, alienists and educators occupy a status other 
than that of the Binet tester. Accordingly 74 per cent of 
the testing is done by Binet testers. 

2. The extent of preparation of the great majority of 
the Binet testers (cf. data given in the column in the 
table entitled 'extent of preparation of psychological 
examiners') consists in having taken normal school, col- 
lege or university courses in the usual branches of educa- 
tion and psychology, and a summer course on mental tests 
and on feeble-minded children ; or in having taken a 
regular medical course and then reading literature on 
feeble-minded and backward cliildren, learning to give the 
Binet system, or paying a visit to a psychological clinic. 
Even if we concede that it is possible thus to prepare 
psycho-educational testers, the conclusion remains true: 
that such testers are not expert psycho-educational diag- 
nosticians, and that to prepare expert psycho-educational 
diagnosticians requires three or four years of technical 
training and clinical experience. 



396 MENTAL HEALTH OF SCHOOL CHILD 

3. The vast majority of psychological examiners are 
educators. By including among the educators the clinical 
psychologists, psychologists, teachers, supervisors, prin- 
cipals and superintendents (a total of eighty-eight), and 
among the physicians the medical inspectors, alienists or 
neurologists (a total of twenty-seven), it appears that 77 
per cent of the examiners are educators and only 23 per 
cent are physicians. This represents, I believe, a true 
appreciation of what the problem of mental exceptionaHty 
involves. The psychological diagnosis of school children 
cannot be divorced from their educational diagnosis. It 
is essentially pyscho-educational in its nature. Its aim is 
essentially educational, the correct pedagogical classifica- 
tion and differential pedagogical training of the child. 
Therefore the directing authority in the diagnosis and 
training of educationally exceptional children must be the 
educationist rather than the sociologist, physician, experi- 
mental psychologist, biologist or heredity worker. This is 
no more exclusively a medical problem (except in certain 
cases) than it is exclusively a social, heredity or psycho- 
logical problem. But by 'educationist' I do not mean the 
ordinary teacher, principal, superintendent, or child, 
experimental or educational psychologist ; I refer to the 
technically trained psycho-educational examiner who pos- 
sesses the qualifications described on pp. 114 f., 132 f., 
157 f., 210 f., and 216 f. 

Moreover, that the psj'^chological examination of school 
children is already regarded as a function of the schools 
is indicated by the fact that in the overwhelming majority 
of cities the examinations are now conducted in the edu- 
cational divisions rather than in the departments of 
medical inspection or in the boards of health. Sixty-four 



PUBLIC SCHOOL PROVISIONS 397 

cities conduct the examinations in the educational divisions 
of the schools and only twenty-two in the divisions of 
medical inspection. The two divisions conduct the exami- 
nations jointly in some cities. Moreover, at least seven 
(possibly fourteen) of the departments of medical inspec- 
tion are under the control of the boards of education, so 
that 82 per cent of the work is supported by educational 
boards (exclusive of the cooperative work by outside 
agencies). These figures indicate a growing conviction 
that this work should be placed directly under the execu- 
tive control of the superintendent of instruction. 

The best indication that the schools will not long be 
content with crude or amateurish psycho-educational 
diagnoses is the remarkable growth of the psychological or 
psycho-educational clinics in the schools. Laboratory 
clinics have been established in the following schools : Chi- 
cago, 1898; Rochester, 1907; New York, 1908; Provi- 
dence, Oakland, Hibbing and Cincinnati, 1911 ; Grand 
Rapids, Seattle, Philadelphia, Springfield, Mass. (sup- 
ports a psychologist on part time). New Orleans and 
Milwaukee (temporarily discontinued), 1912; Buffalo, 
Washington, Albany, Los Angeles and Trenton, 1913, and 
Detroit, 1914 (supports a consulting psychologist on part 
time) — a total of nineteen public school clinics." 

2 The first twelve psychological clinics established in any kind of 
institution (including the institutional psychological laboratories) are, 
in the order of organization: University of Pennsylvania, 1896; Chi- 
cago Public Schools and Minnesota School for the Feeble-Minded and 
Colony for Epileptics, 1899 (discontinued but reestablished in 1910); 
McLean Hospital, Waverley, Mass., 1904; The Training School at 
Vineland, N. J., 1906; Rochester Public Schools and Government 
Hospital for the Insane, Washington, D. C, 1907; Colorado State 
Teachers' College, Greeley, 1908; University of Washington, Univer- 
sity of Minnesota, Lincoln State School and Colony of Illinois, and 



398 MENTAL HEALTH OF SCHOOL CHILD 

Several other cities already have good rudimentary 
clinics, and others are ready to organize clinics.^ It is safe 
to prophesy that witliin the next five or ten years every 
city with a population of 100,000 and over will have its 
school psycho-educational clinic, and smaller cities will 
make some provision for the more adequate psychological 
examination of their mentally exceptional school children. 

All of the existing clinics are under the control of the 
superintendent of instruction except four, two of these 
being administered by the board of health (Buffalo and 
Providence), one by the department of medical inspection 
(Philadelphia) and one by a municipal university (Cin- 
cinnati). Six of the directors of these clinics are clinical 
psychologists. However, by adding two medical directors 
who have considerable psychological training and extensive 
experience with the feeble-minded, and three psychologists, 
the number may be increased to eleven. Only two or three 
clinics are in charge of medical inspectors, one is in charge 
of an alienist, and three are in charge of Binet testers. 

Juvenile Psychopathic Institute, Chicago, 1909. Psychological testing 
was begun on a small scale in the Los Angeles public schools in 
1895, but a psychological clinic was not established as an independent 
division until July, 1913. 

3 On April 14, 1914, the Board of Education of the city of St. Louis 
authorized the establishment of a 'psycho-educational clinic,' as an 
independent division in the department of education, and appointed 
the writer as the first 'director.' The clinic will be located on the 
grounds of the Harris Teachers College, with which it will be closely 
affiliated. The director of the clinic will have administrative super- 
vision of the clinical and educational work with mentally unusual 
children. The actual work of class supervision will be in charge of 
a special supervisor, working under the directions of the clinic. The 
director will ofl'er courses at the Harris Teachers College on mentally 
exceptional children. The form of organization adopted by St. Louis 
corresponds, in the main, to the plan suggested on p. 375. 



PUBLIC SCHOOL PROVISIONS 399 

Number of Psychological Clinics in All Kinds of 
Institutions. 

In public schools, as above 19 

In universities (see p. 57), including the Psycho- 
pathic Laboratory in the School of Education, 

University of Chicago 17 

In medical schools (see p. 58) 7 

In normal schools (see p. 58) 3 

In Girard College 1 

In institutions for the feeble-minded and epileptic 
(including Lapeer, which has a consulting psy- 
chologist, see p. 70f.) 6 

In hospitals for the insane (these clinics perhaps are 
psychological laboratories rather than psycho- 
logical clinics, see p. 70) 5 

In penal and correctional institutions (see p. 78) . 6 

New York Probation and Protective Association . 1 

In juvenile courts (see p. 74) 2 

In municipal criminal courts (Boston and Chicago) 2 

In immigrant stations (Ellis Island) .... 1 

Total 70 

(According to recent press reports, psychological 
examinations are also given in clinics established in con- 
nection with the criminal branch of the municipal court in 
the city of Cleveland and in connection with the juvenile 
court in Philadelphia. The Ohio Board of Control for 
state institutions is erecting a central observation cottage, 
which will serve as a clearing-house for children who are 
to be sent to institutions. Here defectives and delinquents 
of doubtful mentality will be given a mental and physical 
examination before being placed in an institution. The 
Board is given the power to examine and transfer cases. 
No special legislative appropriation has yet been made for 



400 MENTAL HEALTH OF SCHOOL CHILD 

this clearing-house which, evidently, Avill contain a psycho- 
logical clinic.) 

Seventy-five cities, or 75 per cent of the cities tabulated 
in Table IV, pay increased salaries to teachers of back- 
ward and feeble-minded children, 8 per cent give no 
increase, 3 per cent of the answers are ambiguous, and 13 
per cent failed to reply to the question. One city gives an 
initial increase of $300 ; two cities an increase of $250 ; 
one, $240; eight, $200; one, $160; three, $150; thirty- 
one, $100; one, $75; one, $60, and thirteen, $50. New 
York pays a minimum of $860 and a maximum of $1,820, 
with a $100 annual increase. The advance most frequently 
given is thus $100 a year, followed by $50 and $200. 

The justification for raising the salaries of special-class 
teachers is twofold. First, the arduous nature of the work, 
I am not certain, however, that this point is well taken, 
for, while subnormal children require far more drill, 
individual attention and patient care than normal children, 
the special teacher is relieved of the drudgery, monotony 
and formalism incident to mass instruction and the dis- 
cipline of large numbers of children. Many teachers who 
desire to escape from the lock-step of class work will 
regard the opportunities of doing individual work with 
small numbers as sufficient compensation in itself. 

Second, the specialized preparation required by the 
work. The teacher of the special class must be an expert ; 
she must be able to 'psychologize' each pupil and individ- 
ualize instruction ; she must be able to grasp the essen- 
tials of the diagnosis submitted with cases on admission, 
so that she can adapt treatment to individual needs ; she 
must be able to observe scientifically, so that she can 
modify and adapt her methods to the developmental needs 
of each pupil; she must be thoroughly grounded in cor- 



PUBLIC SCHOOL PROVISIONS 401 

rective pedagogics ; in a word, she must be an expert in 
orthophrenics. But no teacher can be considered an expert 
in this field who has not pursued extended technical courses. 
A professional course pursued during a summer term 
suffices merely to lay a good foundation. 

That school administrators are gradually becoming 
con\dnced that no one should be appointed to teach a 
special class who has not made a special study of the 
problems, is apparent from an examination of Table V. 
Seventy-two, or 70 per cent of the 102 cities tabulated, 
answered in the negative (or gave data which seemed to 
justify a negative answer) the question, 'Do you appoint 
teachers of special classes for the feeble-minded and seri- 
ously backward who have not received special prepara- 
tion?' However, this figure is probably slightly too high, 
because it includes cities which propose in future to 
require special training as the eligibility condition for 
appointment, and cities which expect teachers to take a 
training course after instead of before appointment (this 
may be good for the teacher, but it is bad pedagogy and 
hard on the pupils). Moreover, gratifying as these results 
are, it should be stated that the standards of what con- 
stitutes 'special preparation' for this work are still quite 
vague and fluid. Shall we regard as 'specially trained' 
teachers who have taken a kindergarten course, or who 
have merely taught young children, or who have taken or 
taught a little industrial work, or who have merely observed 
the work of a special class for a few weeks ? Hardly. The 
training which teachers need for this work is just as 
specific, precise, detailed and extended (in fact, more 
extended) as the training needed to become an expert 
kindergartner, or manual or domestic arts teacher. New 
York City is, I believe, the only city in the country which 



402 MENTAL HEALTH OF SCHOOL CHILD 

gives a special eligibility examination to all candidates for 
appointment to a special class for feeble-minded and 
seriously backward children. 

Ungraded Classes 

About 102, or 33 per cent of the 302 cities reporting, 
maintain ungraded classes. This is exclusive of one city 
in which the principals give a little attention to slow pupils, 
and of a few cities in which the classes are divided into slow, 
medium and fast divisions, and in which the slow pupils are 
given industrial work. But it includes cities in which 
teachers give individual instruction before, during and 
after school hours, during the regular terms or the summer 
term only, to pupils separately, or in ungraded classes, or 
in the regular grades, in small groups or in unlimited 
numbers, by substitute, assisting, unassigned, ungraded or 
regular teachers. It includes cities in which the instruc- 
tion is available to the slow pupils in all grades, or is limited 
to those in the first three or four grades or to those in the 
seventh and eighth grades. It is evident from the returns 
that the types of ungraded class organization wliich obtain 
throughout the country have httle in common except the 
element of coaching or individual attention. It is also 
evident from many of the repHes that the function of these 
classes is frequently confused with the function, on the one 
hand, of the elementary industrial classes and with the 
function, on the other hand, of the special (orthogenic) 
classes. It is quite clear to my mind that the ungraded 
class has become the dumping-ground for the misfits of 
the schools, just as the special class once was (and still is 
in many places) the dumping-ground for the flotsam and 
jetsam of the schools. Here one finds all types and all 
grades of deviating children, from the imbeciles and 



PUBLIC SCHOOL PROVISIONS 403 

morons to the 'motor minded' or industrially inclined. It 
has been my fortune to examine a considerable number of 
pupils who have been consigned by the educational authori- 
ties to the ungraded classes because they 'were merely 
temporarily retarded on account of absence, sickness or 
transfer and therefore needed only individual attention 
from the ungraded teacher.' I have frequently marveled 
over the blundering diagnoses which have consigned 
morons and seriously backward children to the coaching 
classes, as well as children who should be given academic 
work almost entirely in correlation with elementary indus- 
trial training. There is no justification for the supposi- 
tion that psycho-educational diagnosis is necessary only 
for the extreme abnormal types, and not for the cliildren 
who grade nearer the normal. The correct diagnosis of 
some of the latter is no mean task. There is urgent need 
for a thoroughgoing study of all aspects of ungraded class 
organization. What is the most efficient type of organi- 
zation.'^ Should the class merely be divided into slow, 
normal and fast divisions, and each division be instructed 
by the regular teachers, or should the slow pupils be 
grouped together in a separate ungraded class, or should 
they be taken out occasionally, singly or in small groups, 
and be given special attention by ungraded teachers.'' 
What should be the enrollment of the ungraded class.'' 
The practice varies considerably. In twelve of the cities 
tabulated the register is 20 ; in eleven, 25 ; in nine, 15 ; in 
four each, 20 to 25, and 15 to 20 ; in three, 24 ; in two each, 
20 to 24, 15 to 18, 12, and 30. In others it varies from 
15 to 70, 20 to 30, 5 to 20, 5 to 12, 4 to 9, 3 to 8 and 1 
to 4 (the latter figures probably refer to the size of groups 
instead of classes). In thirty-eight cities the register is 
between 20 and 30 (inclusive), in thirty between 15 and 



404 MENTAL HEALTH OF SCHOOL CHILD 

20 (inclusive), and in eight less than 14. What is the true 
function of the ungraded class? What are the practical 
results of ungraded work? What types of pupils are 
really benefited by individual coaching in the regular 
academic branches? What are the qualifications required 
by the 'ungraded' teacher? What special preparation 
does she require? It is obvious that a teacher who is 
unable to study each child, to unearth the causes of his 
peculiar pedagogical handicaps, to psychologize the child 
and individuahze the instruction, has little place in the 
ungraded room. All these questions deserve careful study. 

From the following tabulation it appears that the 
feeble-minded and backward classes are relatively more 
numerous in the larger cities (above 25,000), while 
ungraded classes are relatively more numerous in the 
smaller cities (below 25,000) : 

Percentages of the 302 cities maintaining 

Special Classes Population Ungi'aded Classes 

Per cent Per cent 

84 over 100,000 74 

43 25,000 to 100,000 35 

17 under 25,000 20 

This is probably not due to the fact that there are rela- 
tively more feeble-minded and seriously backward pupils 
in the larger cities, but is due to the fact that the smaller 
cities have not yet become thoroughly alive to the admin- 
istrative educational problems affecting these children. 
The alleged explanation that there are not enough seri- 
ously deficient children in smaller cities (say, conserva- 
tively, in cities of 10,000 and over) to make up a class, is 
without foundation. 

For data bearing on the other types of special classes 
the reader is referred to Tables VII to XV. 



TABLE II 

Classes for the Feeble-Minded and Seriously Backward 



Cities of 500,000 and over 



City 


Year 
Started 


No. of 

Pupils 

per Class 


No. of 
Classes 


Types of Pupils, or Character 
of Class 






7 to 20 
15 

20 

10 to 20 

15 

16 ave. 

15 

15 


1 
30 

50 
17 
180 
90 

1 

34 




Boston, Mass 

Chicago, 111 

Cleveland, O 

New York, N.Y 

Philadelphia, Pa 

Pittsburgh, Pa 

St. Louis, Mo 


1899 

1898 
1879 
1900 
1901 
1912 

1907-08 


Mental defectives of the im- 
provable type 

Subnormal and backward 

Classes for backward children 

F.-M. and seriously backward 

Orthogenic classes 

F.-M. and backward; more in 
process of organization 

480 pupils in 13 'special schools' 
for the backward and defi- 
cient 



Cities of 250,000 and less than 500,000 



Buffalo, N. Y 

Cincinnati, O 

Detroit, Mich 

Jersey City, N. J. 



Los Angeles, Cal. . . 

Milwaukee, Wis 

Minneapolis, Minn. 

Newark, N. J 

New Orleans, La.. . 



San Francisco, Cal. 



Washington, D. C. 



1906 



1909 


15 


7 


1909 


15 


10 


1903 


15 
15 




1911 


8 


1902 


12 


2 


1908 


12 


4 


1912 


15 


4 


1910 


15 


15 


1910 


14-15 


1 



Mentally subnormal 

F.-M. 

F.-M. classes 

For those '3 years below nor- 
mal' 

Defectives 

Subnormal 

F.-M. 

Defectives (F.-M.) 

'An auxiliary class (ungraded) 
of exceptional children' 

'Ungraded class for defect- 
ives. Hope to organize a 
school' 

F.-M. and seriously back- 
ward ; 4 colored ; 10 white 



Cities of 100,000 and less than 250,000 



Albany, N.Y 

Birmingham, Ala. 
Bridgeport, Conn. 
Cambridge, Mass. 

Columbus, O 

Dayton, O 

Denver, Col 

Fall River, Mass.. 



Grand Rapids, Mich. 
Indianapolis, Ind. . . . 

Louisville, Ky 

Lowell, Mass 



Nashville, Tenn. 



New^ Haven, Conn. 
Oakland, Cal 



1906 
1913 
1909 
1911 
1911 
1913 

1910 
1907 
1913 



1913 
1911 



12-20 

10 

20 

15 

15-20 



10 
15 

12-15 
16-18 
12-14 



(?)40 



Classes for F.-M. and seriously 
backward 

F.-M. 

Defective 

Deficient children 

'Slow and mentally defective' 

One school for defectives 

Mentally defective 

At present only special obser- 
vation classes 

F.-M. 

Two schools for defectives 

Defectives 

Send abnormals to state 
school for F.-M. 

Retarded (?); 4 teachers in 1 
bldg. 

'Subnormal' 

Subnormal 



Cities of 100,000 and less than 250,000 (continued) 



City 


Year 
Started 


No. of 

Pupils 

per Class 


No. of 
Classes 


Types of Pupils, or Character 
of Class 


Paterson, N. J 

Portland, Ore 


1912 


15 
8-12 
18 
15 
15 
12 
15 


4 


Mentally deficient 


Providence, R.I 


1896 
1910-11 
1906 
1910 
1911 
1913 
1910 


8 
3 

29 
10 
2 


F.-M. 


Rochester, N.Y 

Seattle, Wash 


Subnormal 
F.-M. 


Spokane, Wash 


Defective 


Toledo, O 


is 

18-24 


15 
16 


F.-M. and seriously backward 






ward 



Cities of 25,000 and less than 100,000 



Allentown, Pa. 
Altoona, Pa. . . 



Auburn, N. Y. . . 

Aurora, 111 

Bayonne, N. J.. . 
Brockton, Mass. 
Camden, N. J. . . 



Chester, Pa. 
Decatur, 111. 



Elgin, 111 

Elizabeth, N.J. 

Erie, Pa 

Ft .Wayne, Ind. 

Harrisburg, Pa. 
Houston, Tex.. 



Kalamazoo, Mich. 



Lancaster, Pa 

Little Rock, Ark.... 

Lynn, Mass 

Maiden, Mass 

Mt.Vernon, N.Y. ... 
New Britain, Conn. 
New Rochelle, N. Y. 

Newton, Mass 



Niagara Falls, N. Y. 

Passaic, N. J 

Perth Amboy, N. J. 
Reading, Pa 



Saginaw, Mich 

Salt Lake City, U. . 

Schenectady, N. Y. 
Somerville, Mass.. . 
Springfield, Mass.. 

Superior, Wis 

Tacoma,Wash 

Trenton, N.J 

Waltham, Mass 



W. Hoboken, N. J. 



1910 
1914 

1911 
1912 
1911 



1912 
1912 



1903 
1909 
1910 



1910 
1908 



1912 

1912 
1909 
1909 
1913 
1907 



1906 

1912 
1907 
1912 
1908 

1907 



1912 



15 
8-15 

10-12 
15-18 

15 
20-30 

15 

17 
4 



20 
14 

8-12 

10-12 
11 
16 
15 
17 
12 

10-20 



15-20 
15 
15 
20 

10-15 



1912 


20 


1910 


15 


1897 


15 


1911 


5-12 


1910 


10 


1905 


10-15 



F.-M. 

Expect to start a class for 
'mental defectives' in 1914 

F.-M. 

F.-M. and speech defectives 

F.-M. 

Defectives 

Institutional children and 
mentally weak 

F.-M. and backward 

Classes for F.-M., slow, deaf, 
disciplinary and speech de- 
fective 

F.-M. and retarded 

Mentally inferior 

One school for F.-M. 

State School takes care of de- 
fectives 

F.-M. and seriously backward 

F.-M., seriously backward, 
speech defective 

F.-M. and seriously back- 
ward 

Mentally defective 

F.-M. 

F.-M. 

F.-M. 

Defectives 

Mental defectives 

Classes for F.-M. and seriously 
backward 

Seriously backward ; 4 teach- 
ers 

Subnormal 

Mentally defective 

F.-M. 

Seriously backward, including 
deaf, blind, epileptic 

Mentally defective 

One hundred in one atypical 
school 

F.-M. 

F.-M. 

Mentally defective 

Mentally defective 

Mentally defective 

Mentally subnormal 

Utilize Waltham State School 
for F.-M. 

F.-M. 



Cities less than 25,000 



City 



Year 
Started 



No. of 

Pupils 

per Class 



No. of 
Classes 



Types of Pupils, or Character 
of Class 



Asheville, N. C 








Plan to start classes 


Bloomfield, N.J 




15-21 


2 








below class' 


Englewood, N. J 


1910 


15 


1 


For those '3 years or more 
below normal' 


Everett,Wash 


1911 


15 


1 


Mentally deficient 


Goldsboro, N. C 


1913 


20 


1 


Mentally deficient 


Hackensack, N. J 


1911-12 


15 


3 


Mentally defective 


Hempstead, N. Y 


1913 


20 




Classes for P.-M. and serious- 
ly backward 


Hibbing, Minn 


1913 


15 


1 


F.-M. 


Hoquiain, Wash 


1909 


12 


1 


Subnormal 


Lakewood, O 


1913 


12 


1 


For 'children retarded 4 years 
pedagogically' 




1911 




15 








for exceptional children 


Leominster, Mass 


1912 


15-20 


1 


Seriously backward 


Long Branch, N. J 


1912 


15 


2 


Subnormal 


Mason City, la 


1911 


10-15 


1 


F.-M. 


Montclair, N. J 


1910 


15 


8 


Subnormal 


Morristown, N.J 


1913 


15 


1 


Mentally defective 






15 
15 




Classes for F.-M. 


New Brunswick, N. J... 


1911 


2 


Mentally defective 


N. Bergen, N.Y 


1913 


15 


1 


F.-M. 


Ottumwa, la 


1913 


13-15 


1 


Subnormal 


Pawtucket, R. I 




20 


1 


Seriously backward 


Plainfield, N. J 




15 


3 


For those '3 years or more 










below grade' 


Princeton, N. J 


1913 


15 


2 


Mentally deficient 


Raleigh, N. C 


1913 


28 


1 


Subnormal, seriously back- 
ward 


Somerville, N.J 


1913 


15 


1 


F.-M. and seriously backward 


Stonington, Conn 


1912 


24 


2 


F.-M, included in ungraded 
class 


Summit, N.J 




15 


2 




Washington, Pa 


1913 


18 


1 


For older 'boys 2 years over 
age and truants' 



TABLE III — Character of Examinatio: 
Cities of 500,000 and over 



City 


a 
o 

"S « 

.a m 

.1 £ 

MM 


Character of 
Examination 


Official Conducting 
Examination 




Med. 


Psy. 


Ed. 


Ed. 


Psy. 


Baltimore 


Yes 

Yes 

Yes 
Yes 
Yes 

Yes 


Yes 

Yes 

Yes 
Yes 
Yes 

Yes 

Yes 
Yes 


Yes 

Yes 

Yes 
Yes 
Yes 

Yes 

Yes 
Yes 


Yes 

Yes 

Yes 
Yes 
Yes 

Yes 




Director of Phipps 


Boston 




Clinic 

Med. Insp. for Spec 


Chicago 




CI. 

Clin. psys. ch. stud^ 


Cleveland 




dept. 

Binet tester, spec. 


New York 

Philadelphia 


Psy. City College, 
Insp. of Un. CI. 


tch. 

M.D.'s, psy., grad 
students, insp. of 
Un. CI. 

Chief of med. insp. 


Pittsburgh 




5 M.D. assts., 10 
dist. supts. 


St. Louis 


Yes 


Yes 


Supt. of Spec. CI. 
Clin, psy., Sept., 1914 


Clin, psy., beginning 
Sept., 1914 



Cities of 250,000 and less than 500,000 



Buffalo .... 
Cincinnati 



Detroit. 



Jersey City 

Los Angeles . . . 

Milwaukee 

Minneapolis 

Newark 

New Orleans. . . 
San Francisco. 

Washington . . . 



Yes 

Yes 

Yes 

Yes 
Yes 
Yes 
Yes 
Yes 
No^ 
Yes 

Yes 



Yes 
Yes 



Yes 



Yes 



Yes 
Yes 
Yes 
Yes 
Yes 

Yes 



Yes 
Yes 

Yes 

Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 

Yes 



Yes 
Yes 



Yes 
Yes 
Yes 
Yes 
Yes 
Yes 



Supv. of Spec. CI. 



Supt. of Spec. CI. 
Clin. psy. 
Tch. 
Spec. tch. 



Med. Insp., Binet 

testers 

Psy. of U. of Cinn. 

Supv. of Spec. CI. 

Consulting psych, 
spec, tch.. Spec. Med. 
Insp. and M.D.'s 



Supt. of Spec. CI., 
Med. Insp. 
Clin. psy. 

1 

Spec. tch. 

Spec. tch. 

Director of Dept. oi 

Ed. Research 
Spec. tch. 



Binet tester, clin. 
psy. 



Given the Feeble-Minded and Backward 

Cities of 500,000 and over 



Agencies Conducting 
Psy. Examinations 


Extent of 

Preparation of 

Sch. Psy. 

Examiners 


Extent of Psy. 
Examinations 


Child Study Laboratory 

or 

Psychological CHnic 


Med. 
Div. 


Ed. 
Div. 


Outside 
Agency 


Year 
started 


-.sr' 'W 






Phipps Clinic, 
Johns Hopkins 

State Psycho- 
pathic Hospital, 
Harvard U. 


Phipps Director, a 
leading psychiatric 
authority 


Binet and other lab. 
tests 


None 

None 

1898 
None 

1908 

1912^ 
















Yes 


2 clin. psys., Ph.D.'s 
and 1 asst. 
Courses on mental 
tests and subn. ch. 
'Adequate' 

Med. Director, has 
specialized on subn. 
ch. 

Clin. psy. 

Clin, psy., Ph.D. 


Various psy. and 
anth. tests 
Binet tests 

Not confined to one 
set of tests, test de- 
pends upon the type 
of child 

Binet and other 
psy. tests 

De Sanctis, Binet, 
Healy, Wallin, anth. 
and other tests 
De Sanctis. Binet, 
Healy, Wallin, anth., 
ed., social, heredi- 
tary, etc. 


Ed. 


$15,000^ 


Yes 






Yes 


Yes 


City College 

For 12 years co- 
operation from 
the psy. clin., U. 
of Penn. 
Psy. clinic, Sch. 
of Ed., U. of 
Pittsburgh 


Ed. 
Ed. 


$900 
Nominal 




Yes 


1914, 
Sept. 


Ed. 


$450 
Initial 



Cities of 250,000 and less than 500,000 



Yes 






M.D. Observation at 
clinics 

Director Ph.D. in 
psy., 2 assts. trg. in 
mental tests and 
subn. ch. 

One clin. psy., M.D., 
and spec, tch., cours- 
es in subn. ch. 

Normal and coll. 
grad.. univ. trg. 
Psy., M.A., exten- 
sive experience 


Binet tests 

Binet, anth., and 
other tests 

Binet, form board, 
educational tests 

Binet test principal- 
ly 
Binet, others 


1913 
1911 

1914 

None 
1913 
1912 

None 

None 
1912 

None 

1913^ 


B. of H. 

U. of 
Cinn. 


$438 


Yes 


In B, 
of H. 

Yes 

Yes 

Yes 
Yes 


Dept. of psy., U. 
of Cinn. 

Psy., Dept. of 
Ed., U. of Mich., 
appointed con- 
sulting psy., 
Feb., 1914 


$250 








Yes 


Ed. 

Med. 
Insp. 


$750 




Yes 
Yes 
Yes 
Yes 

Yes 


Dept. of psy., U. 
of Minn. 


Spec. trg. 


Binet tests 

Binet, anth., heredi- 
ty 

Healy, Binet, form 
board, anth. 














Ph.D. in psy. 

Trg. in schs. for pre- 
paring tchs. for de- 
fectives 

Spec. trg. on defect- 
ives in summer schs. 
and univs. 


Ed. 


$3,500* 






U.S. Hospital for 
Insane 






Binet, form board, 
audiometer, spirom- 
eter and other lab. 
tests 


Ed. 


$200 



Cities of 100,000 and less than 250,000 



City 


o 

'■a (=1 

§ a 

3 £ 

O 

O, K 


Character of 
Examination 


Ofificial Conducting 
Examination 




Med. 


Psy. 


Ed. 


Ed. 


Psy. 




Yes 
Yes 


Yes 
Yes 


Yes 
Yes 


Yes 




Director of Medico- 






Psy. Lab. 


Bridgeport 






tester 

Tch., Med. Insp., 




Yes 

No« 

Yes 

Yes 


Yes 
Yes 

Yes 

Yes 


Yes 

Yes 
Yes 


Yes 


Prin., Supt. of pri- 
mary schs. 


Prin. 




Spec, tch., students 


Dayton 

Denver 

Fall River 


Yes 
Yes 


Prin. 
Prin., tch. 


from State U. 
Spec. tch. 
Spec. tch. 

Spec. tch. since 1913 




Yes 

Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 

Yes 

Yes 
Yes 


Yes 
Yes 

Yes 

Yes 
Yes 
Yes 
Yes 
Yes 

Yes 

Yes 
Yes 


Yes 

No" 
Yes 

Yes 
Yes 

Yes 
Yes 
Yes 

Yes 

Yes 
Yes 






Supv. of backward 








and f .-m. 




Yes 
Yes 




Spec. tch. 




Teh. 






Spec. tch. 


Oakland 


Yes 
Yes 
Yes 
Yes 
Yes 

Yes 

Yes 




Clin. Psy., Director 




Prin., spec. tch. 
Tch. 

Grade tch. 
Estimates by tch. 

Prin., tch. 

Tchs. 


of Ch. Study Dept. 


Providence 

Richmond 

Rochester 

Seattle 

Spokane 


Alienist 

Spec. tch. 

Director and Asst., 
Ch. Study Dept. 

Head spec. tch. 
Spec. tch. 


Toledo 


Supt. of Spec. Sch. 











Cities of 25,000 and less than 100,000 



Allentown 



Yes Yes Yes Yes Spec, tch 



Cities of 100,000 and less than 250,000 



Agencies Conducting 
Psy. Examinations 


Extent of 

Preparation of 

Sch. Psy. 

Examiners 


Extent of Psy. 
Examinations 


Child Study Laboratory 

or 

Psychological Clinic 


Med. 
Div. 


Ed. 
Div. 


Outside 
Agency 


Year 
started 


In what 
dept. 


Approx- 
imate 
cost 




Yes 




M.D., M.A., tch., 
sch. administrator, 
work in f.-m. institu- 
tions 


De Sanctis, Whipple, 
Fernald, etc. 

Chiefly Binet 


1913 


Ed. 


$150 


Yes 
























Psychopathic 
HosDital. Dept. 
of Psy., Harvard 
Dept. of Psy., 
State U. 


Psys. and psychi- 
atrists of Harvard 

One tch. with spec, 
trg. on defectives, 
others from books 
Courses on mental 
tests and subn. 


Binet and other tests 

Binet (incidentally), 
results of book and 
indv. trg. 
Binet tests 

Binet tests 










Yes 

Yes 
Yes 


















Clin, psy., State 
Teh. College 
since 1911 
Planning to work 
under State Inst. 
F.-M., Waverley 






11,000 














Yes 


Spec, courses in 
mental tests and 
subn. ch. 


Binet and other tests 


1912 


Ed. 






Ind. U. during 
1910-11 






Yes 


Summer courses on 
subn. ch. 


Binet and other 
indv., and phy. tests 


« 


















Clin. psy. at Yale 


Summer courses on 

subn. ch. 

B.A., grad. work in 

psy. 


Binet and other tests 
Binet and other tests 










Yes 


1911 


Ch. study 
dept. 


$417'° 








B. of 


Yes 

Yes 

Yes 

Yes 

Yes 


Alienist, Butler 

Hospital 




M.D., alienist 

Summer courses on 
subn. ch. 

Summer courses on 
subn. ch. and tests 

Clin. psy. and tch. 
with spec. trg. 




1911 


B. of H. 




H. 


Binet, assoc. tests 
and form board 
Binet, De Sanctis, 
Healy and other 

tests. 








1907 
1912 


Ed. 
Ed. 


$500 




Director of Ch. 
Welfare Founda- 
tion, U. of Wash. 
Clin, psy., U. of 
Wash. 


$50'' 




Binet and other tests 

Binet tests 






Summer courses on 
subn. ch. 



















Cities of 25,000 and less than 100,000 



Yes 



Summer courses on 
subn. ch. 



Binet tests 



Cities of 25,000 and less than 100,000 (continued) 



City 


a 
o 

CO o 

fl •- 

il 
^^ 

O 

p, <u 

WW 


Character of 

Examination 


Official Conducting 
Examination 




Med. 


Psy. 


Ed. 


Ed. 


Psy. 




Yes 
Yes 


Yes 
Yes 


Yes 
Yes 










Yes 




Spec. tch. 


Aurora 








Yes 
Yes 
Yes 
Yes 
Yes 
No 
Yes 
Yes 


Yes 
Yes 
Yes 
Yes 


Yes 












M.D., sch. nurse 






Yes 
Yes 






Chester 














Binet tester 


Elgin 










Elizabeth 


Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 

Yes 
Yes 
Yes 
Yes 

Yes 

Yes 
Yes 


Yes 


Yes 


Prin., tch. 


Spec. tch. 


Erie 


M.D. since 1910 


Ft. Wayne 












Yes 

Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 

Yes 
Yes 
Yes 
Yes 


Yes 
Yes 
Yes 

Yes 
Yes 
Yes 
Yes 

Yes 

Yes 


Yes 
Yes 
Yes 
Yes 




Med. Insp. and spec. 






tch. 
Spec. tch. 






Med. Insp., spec. tch. 


Lancaster 


Prin., spec. tch. 


Prin. 


Little Rock 


M.D. 




Yes 
Yes 
Yes 
Yes 
Yes 
Yes 

Yes 
Yes 




M.D. since 1907 




Prin. 


Spec. tch. 








Supt. 

Prin., grade tch. 










Spec. tch. since 1910 




Spec. tch. 






Spec. tch. 










Yes 


Yes 


Prin. 


Spec. tch. since 1912 







Cities of 25,000 and less than 100,000 (continued) 



Agencies Conducting 
Psy. Examinations 


Extent of 

Preparation of 

Sch. Psy. 

Examiners 


Extent of Psy. 
Examinations 


Child Study Laboratory 

or 

Psychological Clinic 


Med. 
Div. 


Ed. 
Div. 


Outside 
Agency 


Year In what 
started dept. 


Approx- 
imate 
cost 


Yes 








Binet tests 
Binet tests 










Yes 


Ed. dept., Cor- 
nell U., during 
1911 

Clin. psys. in 
Chicago 

Spec. tch. from 
Newark 


Summer courses on 
subn. ch. 


















Yes 


Summer courses on 
subn. ch. 


Binet tests 




















Psych, clin., U. 
of Penn. 




Binet and other tests 
Binet tests 






Yes 


7 years supv. 




































Yes 




Spec. trg. on subn. 
ch. and tests 


Binet tests 








Yes 


























Yes 


Yes 
Yes 
Yes 
Yes 






Binet tests 
Binet tests 












subn. ch. 

Summer courses on 

subn. ch. 

Summer courses on 

subn. ch. 

Summer courses on 

subn. ch. 

M.D. 








Yes 










Yes 




Simple ed. tests 
Binet tests 








Yes 










B. of 












H. 


Yes 
Yes 




Summer courses on 
subn. ch. 

Summer courses on 
subn. ch. 
'Very limited' 


Binet tests 
Binet tests 
Binet tests 
'No spec, tests' 
Binet tests 










Binet tester from 
Vineland, 1913 


































Coll. trg., summer 
courses on subn. ch., 
10 yrs.' experience 
with subn. 






















Yes 






Binet tests 






















Yes 




Summer courses on 
subn. ch. 


Binet tests 



















Cities of 25,000 and less than 100,000 (continued) 



City 



a .2 

S o 



Character of 
Examination 



Med. 



Psy. 



Ed. 



Official Conducting 
Examination 



Ed. 



Psy. 



Reading 

Saginaw 

Salt Lake City . 
Schenectady . . . 

Somerville 

Springfield 

Superior 

Tacoma 

Trenton 

W. Hoboken... 



Yes 

Yes 
Yes 
Yes 

Yes 
Yes 
Yes 
Yes 
Yes 
Yes 



Yes 

Yes 
Yes 

Yes 



Yes 

Yes 
Yes 
Yes 

Yes 
Yes 



Yes 
Yes 
Yes 

Yes 



Grade tch. 

Prin. of atypical sch. 



Prin. and tch. 



Yes 
Yes 
Yes 
Yes 



Yes 
Yes 
Yes 



Yes 
Yes 



Prin. and tch. 
Prin., tch. 
Tch. 



Yes 



Spec. tch. 

Spec. tch. since 1907 
Prin. of atypical sch 
M.D., spec. tch. 

Spec. tch. since 191C 
Director of Psy. Lat 



Supv. of Spec. Ed. 
Spec. tch. since 1912 



Cities of less than 25,000 



Bloomfield 


Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 


Yes 

Yes 
Yes 
Yes 
Yes 
Yes 
Yes 

Yes 


Yes 
Yes 
Yes 
Yes 
Yes 






Spec. tch. since 191; 








Spec. tch. 


Everett 
















Hackensack 


Yes 




Spec. tch. 


Hempstead 






Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 


Yes 




M.D., 1911, spec, tcb 














Med. Insp. 


Leavenworth 


Yes 


Prin., Supt. 1911 


Supt. 


Long Branch 


Yes 


Prin. 


Spec. tch. 








Spec. tch. since 1911 




Yes 

















Cities of 25,000 and less than 100,000 (conti 


nued) 






Agencies Conducting 
Psy. Examinations 


Extent of 

Preparation of 

Sch. Psy. 

Examiners 


Extent of Psy. 
Examinations 


Child Study Laboratory 

or 

Psychological Clinic 


Med. 
Div. 


Ed. 
Div. 


Outside 
Agency 


Year 
started 


In what 
dept. 


Approx- 
imate 
cost 


J 


Yes 

Yes 

Yes 
Yes 

Yes 
Yes 


Psy. clin., U. of 
Penn. for last 5 
years 


Six yrs. contact with 
subn. ch. 


Binet tests 
Binet tests 








1 












M.A., summer cours- 
es on subn. ch. 
M.D.. with spec. trg. 
in psy.. spec. tch. trg. 
in Binet 

Summer courses on 
subn. ch. 
Clin, psy., Ph.D. 








Yes 




Binet and other tests 

Binet tests 

Anth., Healy, Binet 
and other tests 






















1912 


Ed. 


$300 










Yes 
Yes 
Yes 


Clin, psy., U. of 
Wash. 


U. of Wash., clin. 












psy. 

Clin, psy., Ph.D. 

Summer courses on 
subn. ch. 


Binet, anth., social 
and other tests 
Binet tests 


1913 


Ed. 


$200 



















Cities of less than 25,000 





Yes 
Yes 
Yes 




Spec, summer cours- 
es on subn. ch. 
Spec. tch. 

Psy. in U. of Wa.sh., 
spec. trg. 


Binet tests 

Binet tests 

Binet and other tests 

Binet tests 

Binet tests 










Clin, psy., U. of 
Wash. 


























Yes 




summer schs. 
Summer courses on 
subn. ch. 








Yes 










Yes 


Yes 






Binet and reaction 

tests 

Binet tests 

Binet tests 

Binet, Whipple 


1911'= 


Med. and 
Ed. 


$500 






Spec. trg. 


Yes 














Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
















psy. and tests 














Binet tests 
Binet tests 
Binet tests 
Binet tests 












Spec, summer course 
on subn. ch. 
Summer courses on 
subn. ch. 

Spec, trg., state cer- 
tificate 







































Cities of less than 25,000 (continued) 





c 
.0 










Character of 
Examination 




Official Conducting 
Examination 


City 


M PQ 










Med. 


Psy. 


Ed. 


Ed. 


Psy. 


Muskegon 


Yes 


Yes 


Yes 


Yes 


Teh. 




Med. B., Supv. spec 

cl. 

Spec, tch., 1911 




Yes 
Yes 


Yes 


Yes 
Yes 








N. Bergen 

Ottumwa 








Yes 




Yes 


Yes 


Supt. 


Prin., tch. 


Supt., Prin., tch. 


Plainfield 


Yes 


Yes 


Yes 


Yes 


Prin. 




M.D., spec. tch. 


Princeton 


Yes 


Yes 


Yes 








M.D., spec. tch. 


Raleigh 

Somerville 


Yes 


Yes 


Yes 






Spec. tch. 


Yes 


Yes 


Yes 






Spec. tch. 


Summit 


Yes 


Yes 


Yes 






M.D., spec. tch. 


Washington 


No 























Annual budget, 18,000. 

Not an organized department. 

Examinations are made after assignment. 

Total amount of budget for Department of Research. 

The nucleus of a laboratory has been formed. 

Examination is given after admission. 

Equipment contributed by friends. 

Except that one or two special teachers voluntarily examine some pupils. 

May start a clinic in 1914-15. 

Classroom equipment, $911. 

Also have use of the equipment of the University of Washington. 

In modified form. 



Cities of less than 25,000 (continued) 



Agencies Conducting 
Psy. Examinations 


Extent of 

Preparation of 

Sch. Psy. 

Examiners 


Extent of Psy. 
Examinations 


Child Study Laboratory 

or 

Psychological Clinic 


Med. 
Div. 


Ed. 
Div. 


Outside 
Agency 


Year 
started 


In what 
dept. 


Approx- 
imate 
cost 


Yes 


Yes 
Yes 
Yes 
Yes 
Yes 
Yes 

Yes 
Yes 
Yes 




Summer courses on 

subn. ch. 

Summer courses on 

subn. ch. 

Both have special 

courses on subn. ch. 


Binet, anth., and 
other tests 
Binet tests 

Binet tests 










































Both, summer 
courses on subn. ch. 
Teh. spec. trg. in 
psy. 

Summer courses on 

subn. ch. 

Summer courses on 

subn. ch. 

Both, spec. trg. on 

subn. ch. 


Binet tests 

Ed. and Binet tests 

Binet tests 
Binet tests 
Binet tests 










Dept. of Psy., 
Princeton Univ., 
1913 































































Abbreviations : 

Anth.=anthropometric. Assoc. =association. Asst.=Assistant. 

Back.=backward. B. of. H.=Board of Health. 

Clin. Psy.=clinical psychologist. Cl.=class or classes. Ch.=children. 

Dept.^department. 

Ed.=educational. F.-M.=feeble-minded. Grad.=graduate. 

Indv.=individual. Lab.=laboratory. Med. Insp.=medical inspector. 

Psy.=psychologist or p.sychological. Prin.=principal. 

Spec. trg. =special training. Supv.=supervisor. Spec.=special. Sch.=school. 

Subn.=subnormal. Spec. tch.=special teacher. 

Un.=ungraded. 



TABLE IV 

Annual Salary Increase for Teachers of Special Classes 

FOR THE FeEBLE-MiNDED AND BACKWARD 



Cities giving an increase of $240 or more: 

Muskegon (start at $300 above regular scale) ; Buffalo, Harris- 
burg ($250); Los Angeles ($240). 
Cities giving an increase of $200 to $150: 

Bayonne, Detroit, Elizabeth, Lakewood, Louisville, Montclair, New 
Haven, Richmond ($200); North Bergen ($160); New Brunswick, 
Paterson, Superior ($150). 
Cities giving an increase of $100: 

Boston, Bloomfield, Bridgeport, Cambridge, Columbus, Cincinnati, 
Everett, Grand Rapids, Hackensack, Hempstead, Houston, Lynn 
(expect to give $100 increase), Milwaukee, Minneapolis, Morristown, 
Mt. Vernon, Newark, New Britain, New York, Philadelphia, Plain- 
field, Portland, Providence, Raleigh, Reading, Saginaw, Schenectady, 
Somerville, Spokane, St. Louis, Trenton. 
Cities giving an increase of $75 to $50: 

Somerville, Mass. ($75); Jersey City ($60); Auburn, Baltimore, 
Brockton, Chester, Chicago, Dayton, Denver, Fall River, Little Rock, 
Memphis, Passaic, Rochester, Worcester ($50). 
Cities giving an increase of 50 to SO per cent over regular scale: 

AUentown (50 per cent increase) ; Lancaster (some get 50 per cent 
increase) ; Goldsboro (33.3 per cent increase) ; Newton (head teacher 
gets 33.3 per cent increase over highest paid teacher). 
Cities stating the amount of salary given or giving an indefinite 
increase : 

Birmingham ($100 per month); Elgin (not settled); Englewood 
(slight increase) ; Hibbing (about $500) ; Pawtucket (same as 
grammar maximum) ; Princeton ($1,000 per year) ; Summit ($900 
to $1,000 per year) ; Niagara Falls ($75 per month) ; Indianapolis 
(slight increase over maximum grade salary) ; Mason City ($10 
more than regular scale) ; New Orleans (tendency to increase) ; 
Springfield (amount varies) ; Washington, D. C. (one grade higher 
than regular teacher). 
Cities granting no salary increase: 

Albany, Cleveland, Maiden, Oakland, Ottumwa, Perth Amboy, 
Seattle, Tacoma. 
Cities giving no reply: 

Aurora, Camden, Decatur, Hoquiam, Kalamazoo, Leominster, Nash- 
ville, New Rochelle, Salt Lalie City, San Francisco, Stonington, 
Waltham, Washington, Pa. 



TABLE V 
Qualifications of Teachers of Backward and Feeble- 
minded Classes 



Cities not appointing teachers without special preparation: 

Albany (plan to send teachers for special training — one teacher has 
had training), Allentown, Altoona (will place a trained teacher when 
class is started), Auburn, Baltimore, Boston, Bloomfield, Birmingham, 
Bridgeport, Buffalo, Cambridge, Chester, Cincinnati, Dayton, Denver, 
Detroit (expect teachers to take training after appointment), Elgin, 
Elizabeth, Englewood, Everett, Fall River, Goldsboro, Grand Rapids, 
Hackensack, Harrisburg, Hempstead (try to get especially trained 
teacher), Hibbing, Hoquiam, Houston, Indianapolis (both teachers 
have special training), Jersey City, Kalamazoo, Lakewood, Long 
Branch, Los Angeles, Louisville, Lynn, Mason City, Minneapolis, 
Montclair, Morristown (special teacher has had training and two 
years of experience), Newark, New Brunswick, New Haven, New 
York, North Bergen, Niagara Falls, Oakland, Passaic, Paterson, 
Perth Amboy, Plainfield, Portland, Princeton, Providence, Raleigh, 
Rochester (teachers who are adapted and show special ability to take 
training), Saginaw (appointed with the understanding that they are 
to get training), Schenectady, Seattle, Somerville, Mass. (teachers are 
to take special training after appointment), Somerville, N. J., 
Spokane, Springfield, Summit, Superior, Tacoma, Toledo, Trenton, 
Washington, D. C, Washington, Pa., West Hoboken. 

Cities appointing teachers without special preparation: 

Bayonne, Brockton, Chicago, Erie, Maiden, Milwaukee, New Britain, 
New Orleans, Newton, Oakland, Ottumwa, Philadelphia, Reading, 
Rochester, Stonington, Worcester. 

Cities appointing teachers for other reasons: 

Columbus (select teachers who are optimistic and skilled in indus- 
trial work), Lancaster (have thus far selected teachers because of 
apparent adaptability), Solvay (teachers appointed who are espe- 
cially qualified for this work), St. Louis (appoint teachers with 
inclination and adaptability). 

Cities giving no reply: 

Aurora, Decatur, Leominster, Mt. Vernon, Muskegon, Nashville, 
New RocheUe, Pawtucket, San Francisco, Waltham. 



TABLE VI 

Ungraded Classes 



Cities of 500,000 and over 



City 



Year 

Started 



■ P,0 

3- 



OS 



Character of Class 



Increase of 

Salary 

per Year 



Baltimore, Md. 
Boston, Mass.., 



Chicago, lU 

Cleveland, O.... 
New York, N. Y. 



Philadelphia, Pa. 
Pittsburgh, Pa... 



St. Louis, Mo. 



Many backward classes 

'Ungraded classes for retard- 
ed pupils' 

No report 

Ungraded 

18,746 pupils in E classes for 
backward pupils capable of 
rapid restoration 

No classification as 'ungraded' 

60 tchs. coach individuals in 
small groups 

4 schools for 'children who 
cannot best be cared for in 
regular grade schools' 



$50 



None 



$100 



Cities of 250,000 and less than 500,000 



Buffalo, N. Y 








A large number of classes for 
'pupils without mental de- 






















fect, but retarded' 




Cincinnati, O 


1910 


25 


8 


'Retarded, all types' 


$50 


Los Angeles, Cal 


1902 


20-24 


75 


Ungraded 


1240 


Milwaukee, Wis 


1912 


15 


30 


Over age, but not mentally 
defective 


$100 


Newark, N.J 


1913 


25-30 


2 


Retarded 


$100 




1910 


















half-time kindergartners in 












afternoons 




Washington, D. C. . . 


1905-6 


16 


1 














operation' 





Cities of 100,000 and less than 250,000 



Albany, N. Y 


1913 
i9i2' 


20 


46 

25 
-25 


2 
1 


One ungraded school 

Ungraded 

Backward 

'Principal looks after pupils 
retarded' 

One school, vocational sum- 
mer classes, continuation 
classes 

Ungraded 

Retarded and ungraded 

Ungraded 

Backward 

For pupils failing to do regular 
work, also 8 industrial class- 
es, since 1910 

Retarded 

15 to 20 substitute teachers 
work with the backward 

Over age, exceptionally dull, 
bright 


Principal's 
salary 


Bridgeport, Conn... 


$50 




1911-12 

1911 
1913 

1910 
1909 
1908 

1913 
1912 

1911 






$50 


Denver, Col 

Fall River, Mass 

Grand Rapids, Mich. 


15 
5 
20 


20 
-18 
-20 
-25 


20 

2 

8 

21 

10 

1 


$50 
$50 

$50 


Kansas City, Mo 


15 


-18 












5 


$50 









Cities of 100,000 and less than 250,000 (continued) 



City 


Year 
Started 


•'Su 

o a 


14-. D 
Bl 


Character of Class 


Increase of 

Salary 
per Year 


Oakland, Cal 


1912 

1907 
1912 


25 

20 
25 
8-12 
25 
20-24 
23 

No 
limit 

25' 

15-20 


3 

5 
2 

"3' 

4 
2 

40 
2 


Ungraded, started a long time 
ago, abandoned, opened 
again in 1912 

Ungraded 

Ungraded 

Ungraded 

Ungraded 

Retarded 

Ungraded, 'each school gives 
special help to backward ch.' 

'Ungraded rooms for back- 
ward' 

Ungraded 

Ungraded 

One school for the over age 
and backward 

One school for boys retarded 
2 or more years 

Ungraded 












Portland, Ore 




Providence, R.I 

Richmond, Va 

Rochester, N. Y 

St. Paul, Minn 


1896 
1913 
1910 

1906 

1912 
1907 


$50 

$100-200 

150 


Seattle, Wash 












Toledo, O 










24 


6 


$50 









Cities of 25,000 and less than 100,000 



Camden. N. J 

Charleston, S. C... 
Chattanooga, Tenn. 
Elgin, lU 



Elizabeth, N. J.. 
Fitchburg, Mass. 
Holyoke, Mass.. 



Huntington, W. Va. 



Jackson, Mich.. 
Johnstown, Pa. 
Lancaster, Pa.. 



Lynn, Mass 

Manchester, N. H. 



New Britain, Conn. 

Newport, R. I 

New RocheUe, N. Y. 



Newton, Mass. . . 
Pasadena, Cal.. . 
Portsmouth, Va. 



Poughkeepsie, N. Y. 
Roanoke, Va 



Salem, Mass 

San Antonio, Tex. 



San Diego, Cal — 
Salt Lake City, U. 



Schenectady, N. Y. 
Sioux City, la 



1913 



1911 



1906 
1907-8 



1908 



1912 
1912 



30 

12-18 

14 



20 

20-25 

25 



30 
'16-20' 



15-20 
15-20 



15 
15-70 



20 
4-9 



2-5 



'Excessive age and doubtful 

mentality' 
Ungraded 
Ungraded 
Ungraded for those retarded 

in various subjects 
For boys mentally very slow 
Ungraded, 'coaching' 
Ungraded 

1 teacher in each large build- 
ing coaches the retarded 

Ungraded 

Ungraded 

Sometimes admit 35 on ac- 
count of crowding. Back- 
ward and precocious 

Backward 

'Substitute teachers help 
backward pupils' 

Backward or over age 

Two 'unassigned teachers' 

Ungraded classes for giving 
indiv. attention 

Ungraded 

'Special study rooms' 

'Dull' in certain divisions of 
classes 

Ungraded class 

'Divisions of fast, medium, 
slow' 

Ungraded 

'Teachers take charge of 
rooms' for backward chil- 
dren 

Ungraded 

Ungraded rooms for bright 
and slow 

Ungraded 

Two teachers give individual 
attention in 5 schools 



$50 



Increase 
expected 



$100 



None 



Cities of 25,000 and less than 100,000 (continued) 



City 


Year 
Started 






Character of Class 


Increase of 

Salary 
per Year 




1910 


25 

22 

15-20 

25 

5-12 
Varies 


1 
.... 

9 

4 
3 
2 
4 

1 






South Bend, Ind.... 
S. Orange, N. J 


Ungraded rooms 

Ungraded 

Backward and non-English- 
speaking. Also 2 practical 
arts classes, since 1913 

Special aid 

Ungraded 

'Dull' 

Teachers handle as many as 
possible in ungraded rooms 
for retarded 

Ungraded, 'atypical' 


1150 


Springfield, Mass. . . 


1894 
1911 




Superior, Wis 

Tacoma, Wash 


160 


Trenton, N. J 


1905 
1913 

1912-13 








Wilmington, N. C... 









Cities less than 25,000 



Albuquerque, N. M. 
Appleton, Wis 



Beverly, Mass. . . 
Bismarck, N. D. 



Champaign, 111. 
Concord, Mass. 



Claremont, N. H. 
Denison, Tex 



Eveleth, Minn.. 
Everett, Wash. 



Goldsboro, N. C... 
Great Falls, Mont. 



Hibbing, Minn. 
Hillsboro, Tex. . 



Iron wood, Mich 

Kenosha, Wis 

Lead, S. D 

Long Branch, N. J. 
Ludington, Mich 



Mason City, la 

Munhall, Pa 

New London, Conn. 



Paris City, lU. 



Parkersburg, W. Va. 
Rockland, Me 



Rockland, Mass 

Southington, Conn. 
Stonington, Conn... 



Summit, N. J.. . 
Uniontown, Pa. 



1911 

'i9ii' 



1909 
1911 



1913-14 

1912 

1911-12 

1913 

1912 



1913 
1912 



1912 
'i9i2' 



20 



10-15 

20 

3-8 



16 

20-25 

24 



Ungraded 

Unlimited number handled in 
ungraded classes 

Teachers coach backward 

Ungraded class abandoned 
because of lack of room 

Substitute teachers instruct 
small classes 

Retarded grouped in various 
classes 

Ungraded 

'Industrial instruction to re- 
tarded' 

Ungraded 

Retarded, conducted in 
groups of from 1 to 6 pupils 

Backward 

Individual help before and 
after school 

Rooms for 'backward and 
hand-minded' 

'Misfits, retarded in one or 
more subjects' 

Backward and truant 

Ungraded 

Ungraded 

Ungraded 

Individual attention to excep- 
tional children 

Ungraded 

Ungraded 

One teacher coaches back- 
ward 

'2 divisions in each grade to 
give special attention to re- 
tarded' 

'Special help' in 1 or 2 class- 
es in each building 

'Backward of 7th and 8th 
grades' 

Summer classes for 'repeaters' 

'Opportunity classes' 

'Special classes for 1st three 
grades' 

Retarded 

'Ungraded classes in 1st to 
4th grades' 



$100 



100% 



Slight 
increase 



$90-100 



Cities of less than 25,000 (continued) 



City 


Year 
Started 


No. of 
Pupils 
in Class 


O « 


Character of Class 


Increase of 

Salary 
per Year 


Winchester, Ky 


1901 

1913 

1912 
1911 


1-4 
12 

16' 


1 

1 
1 


'Modification of Batavia plan' 

in every grade 
'Pupils unable to do regular 

work' 
Ungraded 
Ungraded 





















TABLE VII 

Classes for Epileptics 



City 


Year 
Started 


Character of Class 


Baltimore, Md 

Chicago, 111 

Cleveland, O 


1912 
1914 


1 class 

3 classes in process of organization 

1 class 


Reading, Pa 


1908 


Included in class for defectives 



TABLE VIII 

Classes for Disciplinary and Truant 



Cities of 500,000 and over 



City 



Year 
Started 



2. ^l-. 



0,2 



Character of Class 



Chicago, 111. 



Cleveland, O.... 
New York, N. Y. 



Pittsburgh, Pa. 
St. Louis, Mo.. 



1908 
1902 



About 

1874 
1913 



Industrial truant school 

250 pupils in one parental sch. for truants 

Disciplinary and truant 

Disciplinary or truant 

In detention rooms of Juvenile Court 
177 pupils in 1 industrial sch. for depend- 
ent and delinquent 



Cities of 250,000 and less than 500,000 



Buffalo, N. Y 

Detroit, Mich 

Los Angeles, Cal. . . . 
Minneapolis, Minn.. 



1904 
1899 



60 pupils in one parental sch. for truants 

Cls. for incorrigible and truant 

Incorrigible 

100 in 1 bldg. for incorrigible and truant 



Cities of 250,000 and less than 500,000 (continued) 



City 


Year 
Started 


03 




Character of Class 


Newark, N. J 


1898 


20 




5 classes each in 3 schs. Ungraded, dis- 
ciplinary and truant 


Washington, D.C... 


1906 


16-25 




dren's Harbor and Reform Sch.' 
One sch. for disciplinary and truant 



Cities of 100,000 and less than 250,000 



Brockton, Mass 

Dayton, O 

Denver, Col 

Grand Rapids, Mich. 
Indianapolis, Ind. . . . 

Kansas City, Mo 

Louisville, Ky 

New Haven, Conn. 

Oakland, Cal 

Omaha, Neb 

Paterson, N. J 

Portland, Ore 

Providence, R.I 

Rochester, N. Y 

St. Paul, Minn 

Seattle, Wash 

Spokane, Wash 



Syracuse, N. Y. 



1910 
1911 
1910 



1910 



1910 
1913 
1912 



1896 
1899 
1911-12 
1906 
1909 
1913 



25 



For boys 

One sch. for truants and troublesome ch. 

Disciplinary 

One truant sch. 

100 ch. in one truant sch. 

200 ch. in the home of juvenile court' 

'Ch. giving- trouble in discipline and 

attendance' 
Truant and incorrigible 
Disciplinary 

'A special school for boys' 
Incorrigible 

Classes for disciplinary and truant 
Disciplinary 
Truant, 2 teachers 
Two parental and detention schs. 
100 ch. from all grades 
One parental sch. 
CI. for incorrigibles 
Disciplinary and truant 



Cities of 25,000 and less than 100,000 



Bayonne, N. J.. 
Camden, N. J. . 
Decatur, 111. . . . 
EHzabeth, N. J. 



Harrisburg, Pa. . . 
Kalamazoo, Mich. 

Pueblo, Col 

Reading, Pa 

St. Joseph, Mo.... 

Tacoma, Wash 

Trenton, N. J 

Waltham, Mass. . . 



1909 
1912 
1912 
1912 

1902 



1911 
1908 



1905 



Incorrigible 

Troublesome boys 

Included in ungraded school 

'For the obscene in manner, speech and 

action' 
Incorrigible and truant 
Classes 

One sch. for boys 
Truant and incorrigible 
One sch. for truants 
Parental sch. for boys 
Disciplinary and truant 
Sent to 'County Training School' 



Cities of less than 25,000 



Bloomfield, N. J 






1 


Practically incorrigible 




1912 
1910 
1913 
1909 
1913 
1913 






Montclair, N.J 

Morristown, Pa 

Plainfield, N.J 

Princeton, N.J 

Washington, Pa 




1 
1 
1 
2 
2 


Incorrigible 

Incorrigible 

For unruly boys 

Included in speech defective els. 

Incorrigible 



TABLE IX 

Classes for Foreigners 



City 


Year 

Started 


Character of Class 




1912 






Non-English-speaking 




1910 


2 classes 






Cleveland, O 




4 classes for children 'just over' 


Denver. Col 

Fall River, Mass 

Hackensack, N.J 


1911 
1913 

1912 
1913 
1908 
1910 


1 class 

15 classes of children ranging from 10 to 

15 years of age 
Class for foreigners 


Lynn. Mass 

Manchester, N. H 


4 classes 

Classes for non-English-speaking 


New York, NY. 




1,474 pupils in C classes 


Philadelphia. Pa 

Pittsburgh, Pa 

Rochester, N. Y 


1913 
1912 
1899 


2 classes for foreigners 

2 evening classes for adult foreigners 

12 classes 

Industrial sch. for Mexicans who do not 


Solvay, N. Y 




speak English 


Somerville, Mass 


1910 


1 class for foreigners 
Included in ungraded class 


Spring-field, Mass 


1894 


9 classes, included among backward 

classes 
2 classes for foreigners 


Trenton, N. J 

Wa.shinston, D. C 


1905 


1 class for non-English-speaking 
Day (1) and night (12) classes 


Winsted. Conn 




Italians placed in backward classes 









TABLE X 

Classes for the Deaf 



City 


Year 
Started 


Character of Class 




1913 
1912 


Deaf included among speech defectives 


Atlanta, Ga 

Cleveland, O. . 


1 class 


Chicago. Ill 

Dayton, O 

Decatur, 111 

Detroit, Mich 


1895 
1911 
1912 


3 schools 

1 special school 

Included in ungraded class 

Deaf classes 


Grand Rapids, Mich 

Jersey City, N. J 

Kenosha, Wis 

Lancaster, Pa 

Los Angeles, Cal 

Milwaukee, Wis 

Newark, N.J 

New York, N. Y 

Oakland, Cal 

Portland, Ore 


1910 
1911 
1913 
1913 
1900 
1876 
1910 
1909 
1901 


1 .school 

1 class 

Deaf included among speech defectives 

1 school 

4 classes 

17 classes 

6 classes 

30 classes, 9 pupils to each class 

1 class 

Deaf classes 


Reading, Pa 


1908 


Deaf placed in defective class 



Classes for the Deaf (continued) 



City 


Year 
Started 


Character of Class 


Rock Island, 111 

San Diego, Cal 

Saginaw, Mich 

Seattle, Wash 


1903 
1912 
1907 
1911 


1 class, limited to 10 pupils 
1 class 
1 class 
3 classes 


St. Paul, Minn 

Tacoma, Wash 

Toledo, O 


1913 
1909 


1 school 
1 class 









TABLE XI 

Classes for the Blind 



City 


Year 

Started 


Character of Class 


Chicago, 111 


1899 




Cleveland, O 
















Milwaukee, Wis 

Newark, N. J 

New York, N. Y 

New York, N. Y 

Reading, Pa 


1908 
1910 
1907 
1912 

1908 


3 classes 
1 class 

15 classes, 9 in each class 
'Inflammatory eye diseases,' 2 classes, 30 
pupils 







TABLE XII 

Classes for Speech Defects 



City 


Year 
Started 


Character of Class 


Appleton, Wis 


1896 
1912 


For the deaf and speech defective 


Aurora, 111 

Boston, Mass 


Placed in the feeble-minded class 








Decatur, 111 

Detroit, Mich 


1912 


each week 
Placed in ungraded class 


Houston, Tex 

Jersey City, N. J 

Kalamazoo, Mich 


1908 
1911 


Placed in feeble-minded classes 

1 class 

Defective speech classes 


Kenosha, Wis 

Milwaukee, Wis 


1913 
1912 
1912 


Stutterers placed in deaf classes 
12 classes 







Classes for Speech Defects (continued) 



City 


Year 
Started 


Character of Class 


New York, N. Y 

Pittsburgh, Pa 

Princeton, N. J 

Rochester, N. Y 

Rock Island, 111 


1911 
1912 

1913 

1913 


6 classes 

4 visiting- teachers work in different sec- 
tions of city 

'Mentally deficient through speech de- 
fect" 

1 class 


St. Paul, Minn 


1913 


School for speech and hearing defects 



TABLE XIII 

Classes for Bright Children 



City 


Year 

Started 


Character of Class 










1913 




















Harrisburg, Pa 

Hempstead, N. Y 


1902 


1 class for bright pupils 


Lancaster, Pa 

Long Branch, N. J 

Louisville, Ky 

Memphis, Tenn 


1912 
1912 
1910 


Included in ungraded class 

Rapid moving classes 

Special classes for the accelerated 








Montclair, N.J 

Muskogee, Okla 


1910 


1 class for gifted children 


Parkersburg, W. Va 






Pasadena, Cal 

Portsmouth, Va 


1907-8 


Special study rooms 


Salt Lake City, U 




Classes for bright 


Springfield, Mass 

Solvay, N. Y 


1912 


Extra study groups 


Waco, Tex 


1913 
1913 




Washington, D. C 


1 class 



TABLE XIV 

Orthopedic Classes 



City 


Year 
Started 


Character of Class 


Baltimore, Md 

Detroit, Mich 


1912 


3 classes 


Newark, N.J 

New York, N. Y 

Philadelphia, Pa 


1913 
1906 
1913 


1 class 

36 classes, 30 pupils to each class 

Orthopedic, 2 classes 



TABLE XV 

Open Air Schools 



City 


Year 
Started 


Character of Class 


Buffalo, N. Y 

Chicago, 111 

Louisville, Ky 

Minneapolis, Minn 

Newark, N.J 

New York, N. Y 

Pawtucket, R.I 


1910 
1910 
1911 
1911 
1911 
1910 


2 open air schools, 1 in prospect 

11 classes, open air and low temperature 

For anemic children 

2 tubercular classes 

3 tubercular classes, 1 open air 
Tubercular, 20 classes, 23 pupils to each 

class 
Anemic, 41 classes, 21 pupils to each class 


Philadelphia, Pa 


1911 
1912 
1912 




Pittsburgh, Pa 


1 tubercular 

One class for tubercular children (started 
by Tuberculosis League of Civic Club 
of Allegheny County in 1907) . One class 
for anemic children (started by Tuber- 
culosis League in 1911) 















I am indebted to Miss Eva Webb for assistance in tabulating 
these returns, and to my wife for considerable stenographic work 
in connection with the book. 



CHAPTER XIX 

A SCHEMA FOR THE CLINICAL STUDY OF 

MENTALLY AND EDUCATIONALLY 

UNUSUAL CHILDREN 

The scientific study of the educationally exceptional 
child should follow a definite plan of procedure and should 
be sufficiently comprehensive to include an investigation 
of all the important intrinsic and extrinsic factors which 
may mar his development. A complete investigation 
should include the study of the child's developmental, 
family, hereditary and school histories, an investigation of 
his past and present social and physical environment, and 
an examination of his present physical condition and 
anthropometric, educational and psychological status. A 
completely satisfying investigation thus requires the co- 
operation of the social and hereditary worker, the 
teacher, the medical expert and the psycho-educational 
clinician. 

The following schema is offered as a guide to the scien- 
tific examination of mentally abnormal children. It may 
be used in either of two ways. First, the various forms 
may be reprinted on separate blanks with appropriate 
vacant spaces, to be filled in by the investigator. The 
chief objection to this plan is probably financial: blanks 
are expensive, and in few cases will it be possible to fill out 
all the spaces, while in many cases it will not be necessary 
to do so. Second, the investigator may thoroughly 
familiarize himself with the contents of the various forms. 



430 MENTAL HEALTH OF SCHOOL CHILD 

and follow them as a systematic and comprehensive guide 
to liis investigation; but instead of entering the data on 
printed blanks he may write up a 'running history,' giving 
the essential facts of the case, on blank sheets. Whether 
the one plan or the other is followed, it is desirable that 
every investigator should append a brief summary of his 
findings and recommendations. 

It cannot be too forcibly impressed upon social, field 
and laboratory investigators of children that parents and 
relatives— or any from whom bio-social data are sought — 
must be approached with much tact and judgment. 
Gathering hereditary, personal and social data is, at best, 
a very delicate undertaking, subject to many errors, and 
many investigators fail utterly to secure, or otherwise 
they pervert, the significant factors, either because they 
do not know how to approach parents so as to win their 
confidence and put them in a communicative attitude, or 
because they suggest answers by their indiscreet use of 
leading questions. While, therefore, a 'guide' will prove 
of the greatest value to child investigators, they must 
know above all else how to use the guide with tact, common 
sense and discriminating intelligence. 

Social and hereditary investigators must also be 
cautioned against drawing premature or unjustifiable 
conclusions from hearsay evidence. They must accustom 
themselves to weigh reports very carefully, and to verify 
them in every way possible. There is a large amount of 
work done today in heredo-biology, heredo-psychology and 
social investigation which is careless, unscientific and 
worthless. Do not conclude that someone was feeble- 
minded or insane simply because someone reported him 
to be 'slow,' 'stupid,' 'feebly-gifted' or as acting 'queerly.' 
Do not conclude that a child is feeble-minded simply 



SCHEMA FOR CLINICAL STUDY 431 

because he appears stupid or feeble-minded to you, or 
because he happens to test three years, or even four or five 
years, retarded. Science cannot be founded on guess- 
work. Gather all possible facts bearing on your case, 
and avoid hasty generalizations. It is rather for the 
trained specialist to supply the diagnoses. 

It need scarcely be said that when the same person 
gathers the developmental, hereditary and school data, it 
is not necessary to re-record on each blank the identical 
facts called for in the different blanks unless there is a 
discrepancy in the statements. 

FORM I 

DEVELOPMENTAL HISTORY 

Source of data Date 

Age: date of birth 
Address (with 'phone) Father's 

Mother's name Guardian's 

By whom referred for investigation 

(Underscore appropriate words, and All in other data) 

CoNCEPTivE CoKDiTiONs: discases, syj^hilis, gonorrhea, tuberculosis, 
scrofula, alcohol, drugs, health, overwork, starvation, fright, accidents, 
anxiety, excitement, aversion, etc., before or at time of conception in 
mother 
in father 

Pregnancy Conditions: above data for mother during pregnancy. 
Also pelvic diseases, attempts at abortion, 'maternal impressions,' 
legitimacy of child 

Birth Conditions: premature (how much) full term, 

weight labor normal, prolonged (how long) or 

diflBcult; delivery with instruments or anesthesia; diflScult animation, 
breathing or crying, cyanosis; injury or deformity (especially of 
head) or paralysis; inability to suckle 

Growth Conditions: nursed (by whom, how long) 
Bottle fed (how long, what) What fed when 

weaned Sickly as baby or child First 



No. 


Diagnosis 


FuU name 


yrs. 


mos. 


name 




name 


By 



432 MENTAL HEALTH OF SCHOOL CHILD 

teeth, when (any fever or illness) Second teeth, 

when Fontanel, closed when First 

crawled, when Stood alone, when 

Walked (unsupported steps), when Walked well, 

when Ran well, when Supported head, 

when Talked — single words correctly applied, 

when Short phrases, when Complete 

sentences, when Specific speech defects, what, 

since when, circumstances Able to hold or grasp well, 

when Control of fundamental reflexes (acquisition 

of tidy habits), when Beginning of puberty 

Of menstruation (difBcult) 

Diseases and Accidents (age, attributed cause, severity, subsequent 
effects, recovery) : measles, smallpox, whooping cough, scarlatina, 
scarlet fever, mumps, diphtheria, cerebro-spinal meningitis, infantile 
paralysis, rickets, malnutrition, inanition, scrofula, swollen glands, 
adenoids, enlarged tonsils, nose, eyes, ears, nervousness, muscular 
twitches, where chorea, periodical headaches, fainting 

spells, convulsions (infantile or epileptic, with data) 
enuresis (nocturnal or diurnal), falls, injuries, orthopedic deformities, 
pubertal or menstrual troubles Vaccinated, when, 

effects Hospital or surgical record 

M. D.'s by whom examined or treated 
Diagnoses by different M. D.'s 

Habits: sleep (past and present): hours of retiring and arising 
sound, restless, insomnia (cause). Drinking: 
tea, coffee, wine, beer, whisky; drugs (how much, how frequently) 
Appetite: hearty, poor, capricious, gluttonous, food 
preferences, usual menu Chews or smokes: cigarettes, 

cigars, pipe. Excessive indulgence in sweets Masturbates, 

sexually immoral or perverse. 

Mental and Physical Peculiarities in Infancy and Childhood 
(age first observed, parents' explanation) : queer or bizarre ideas, 
action, behavior, speech, disposition Fits of crying or 

laughing, with or without cause Outbreaks, tantrums, 

continuous or periodic Night terrors, sleep-walking 

Morbid fears Criminal, intemperate, immoral or 

destructive tendencies Running away Solitude 

or company preferred Shut-in, solitary disposition 

Playing or seeking younger or older persons or opposite sex 
Dull, stupid, lazy, indifferent, bright, talented, precocious (with 
facts) 



SCHEMA FOR CLINICAL STUDY 433 

Record of Delinquencies (with ascribed causes, institutional, 
court and probation records) : 

Agencies which have previously been interested in this child: 

Additional Remarks: 

Recommendations (by whom) : 

Results of Following Recommendations (as reported later) : 

Signature : 

FORM II 

FAMILY AND HEREDITARY HISTORY 

No. Diagnosis Source of data Date 

Full name Born, where Age: date of 

birth yrs. mos. Lives with at 

(street, with 'phone) Name, with birthplace, nationality 

and religion of father of mother 

Language spoken at home Order of child's 

birth no. of sisters, alive dead of brothers, 

alive dead Age of father at child's birth of mother 

Blood relationship between parents Parents living 

apart, together, divorced. Occupation and weekly earnings of father 

of mother of other children of child 

Health, morals, habits, diseases, sexual habits, etc., prior to birth of 
child, of father of mother (see Form I) 



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SCHEMA FOR CLINICAL STUDY 435 

FORM III 

HOME AND NEIGHBORHOOD ENVIRONMENT 

No. Diagnosis Source of data Date 

FuU name Age: date of birth 

yrs. mos. Address (with 'phone) Lives 

with Parents' address, if different 

Father's name Mother's name 

Parents alive Parents living together If 

separated, divorced or deserted. Guardian's name and address 

Child's birthplace Language spoken in 

home Referred for investigation by 

Successive places of residence (with sanitary, hygienic and moral 
conditions of each) 

Present Home Influences 
(Underscore appropriate words, and All in other relevant data) 

FiNANCiAi: rich, moderate, poor, impoverished, proverty-stricken, 
charity case. Weekly earnings of father mother 

children Breadwinners, who Influence of financial 

conditions on child's care 

Food: quantity quality Drinks: 

what how often how much No. of meals 

(typical menus) 

Clothing: ample, insufficient, shabby, soiled, tasteless, immodest 
(effect on child) 

Bathing: frequency 

Housing: flat, tenement, house; no. of rooms of bedrooms 

bathroom no. of lodgers in family of boarders 

Clean, bright, sunshiny, artistic, attractive, dark, dingy, damp, filthy, 
disordered, well or poorly ventilated. Garbage Sewerage 

Child's bedroom: quiet, good ventilation, light, sleeping companions, 
no. in room Hours of retiring and arising 

Home Life: excellent, tranquil, religious, moral, refined, upset, dis- 
turbed, boisterous, raw, quarrelsome, brutal, fighting, vulgar, degrad- 
ing irreligious, immoral, bad. 

Home Treatment: excellent, good, kindly, good care, indifferent, 
neglectful, poor care, parents away, petted, coddled, well or poorly 
disciplined, ridiculed, rebuffed, irritated, maltreated, whipped, 
frightened, abused, by father, mother, stepmother, siblings, guardians, 
etc. Overworked 



436 MENTAL HEALTH OF SCHOOL CHILD 

Child's Deportment at Home: excellent, good, average, poor, bad; 
obedient, disobedient; mischievous, quarrelsome, fights, cruel to 
animals or siblings or playmates, incorrigible, destructive; cheats, 
steals, squanders money, pawns, gambles, plays craps, deceives, lies, 
untrustworthy; neat, careless, indolent, immodest, immoral; runs 
away. Attitude toward parents, siblings, playmates, strangers 
Toward reprimands and punishment How punished 

Deportment of siblings at home 

Amusemestts at Home: what, cards, games, plays, singing, music, 
reading, proper, improper. How does child spend leisure time? 

Chief interests at home Vacations, 

when where spent 

Work: complete record of jobs, with dates, how long held, hours, 
pay, success, reasons for changes or discharge 
Age on taking first job 

Religious Disposition: religious, irreligious or indifferent. Attends 
church, where, how often, willingly or reluctantly 
Attends Simday school, where, how often, willingly 

Neighborhood Influences 

Physical Surroundings: sanitary, insanitary, dark, smoky, filthy, 
slummy, densely populated, foreign population, saloons, dance halls, 
gambling joints, picture shows, immoral resorts. 

Social Environment: character of chums or associates (boys, girls, 
adults), good, bad, vulgar, gamblers, crap players, immoral, corrupt, 
criminal, thieves. Belongs to clubs or gangs, as leader or follower, what 
kind (social, amusement, literary, predatory, criminal, etc.), effects 
of on child Tendencies toward loafing, vagrancy, migration. 

Recreation facilities of neighborhood: playgrounds, public, private, 
supervised, unsupervised, streets, home yard, athletic field, gymnasium, 
social settlement house. Seeks what kinds of amusements (games, 
plays, loafing, running around, ball, gambling, crap playing, immoral 
practices, selling papers, theaters, picture shows, etc.). Plays with 
boys or girls, older or younger. Attends picture shows or theaters, 
how often What kind of shows preferred 

Effects of on child 

Recommendations: 

Results of Recommendations (from later investigations): 

Signature : 



SCHEMA FOR CLINICAL STUDY 



437 



FORM IV 

SCHOOL HISTORY 

Teachers' Reports on Pedagogical, Psychological, Social and 
Moral Traits 

No. Diagnosis Reported by (with position) 

Date Full name Sex 

Age: yrs. mos. Birthday Address (with 

'phone) Parents' or guardian's name (and address, 



if different from child's) 
and religion of father 
Language spoken in child's home 



Nationality, language 
mother 
By whom referred 



(Underscore appropriate words : once for 'moderate,' twice for 'marked,' and 
thrice for 'extreme' degree. Also fill in data in blank spaces.) 

Attendance Record: Age on entering first school (kindergarten 
included) 



Names of schools 

attended, in 
correct time order 


Location of 
School 


Time, 
from to 


No. of 
months in 
attendance 


Grades 
completed 


Grades 
repeated 


(1) 
(2) 
(3) 
(4) 















Repetition: number of months spent in each grade child has repeated 

Total time (years or months) spent 
repeating work Retardation: grade in which child 

should be according to age Present grade 

Amount of pedagogical retardation (yrs. and mos.) 
Attendance, regular or irregular, during past or present time 
(ascribed causes of irregularity) 

Past Record: character of work, conduct, disposition, traits, etc., 
as reported from previous teachers or specialists 

Present Pedagogical Status: School efficiency in general: excellent, 
good, fair, poor, very poor, total failure. Prospects of promotion: 
excellent, good, fair, poor, none. Poorest work in which branches 
Best work in which branches 



438 MENTAL HEALTH OF SCHOOL CHH^D 

Special aptitudes, what Greatest interests, or likes, in 

school work Greatest dislikes 

Pedagogical traits in which strongest In which 

most deficient Learning capacity: is child good 

or poor in ability to observe to concentrate 

to memorize (mechanically, logically, understandingly) 
to retain to express orally or in writing to 

form habits to adapt self to new or changing situations, 

conditions or emergencies to think, judge, reason, under- 

stand to do independent work to lead 

to direct to originate, invent to keep a level 

head (easily confused) Learns best by repetition, rote, 

memorizing, reasoning, imitation, reading, being told, doing or 
experimenting for self (hit or miss). Accomplishments : in reading: 
knows alphabet (letters not known) reads in what 

reader how well reads at sight, syllables, short 

words, long words, spells out words In arithmetic ; 

counts, how far Ability in addition, subtrac- 

tion multiplication division 

problems How far advanced Best in 

concrete or abstract work In spelling: sample words 

child can speU Words child cannot speU In 

writing In drawing In grammar In 

language work In speaking, dramatizing 

In music In kindergarten In manual train- 

ing In shop work In domestic science 

In school gardening In gymnastics, games In 

history In geography Ability of brothers 

of sisters 
Reported defects or capacities of mother 
of father 

Attitude Toward School Work: interested, willing, tries, indus- 
trious, energetic, cheerful, trustworthy, lazy, slovenly, careless, shirk- 
ing, despairing, diffident, non-persevering, easily wearied or fatigued, 
grows sleepy, dopey, disinterested, bored, inattentive, complaining. 

Attitude Toward Correction, Reproof or Punishment: heedless, 
resentful, headstrong, obstinate, talks back, abusive, sensitive, cries, 
indifferent. Very responsive, tries to improve, takes it with good 
grace. 

Attitude Toward Plays and Games: seeks or avoids games. Plays 
much or little. On playground Plays with boys or 

girls with younger or older children 



SCHEMA FOR CLINICAL STUDY 439 

Fond of what games or plays Plays make-believe 

plays ability to plan or lead games 

Gets confused in games Loses self-control 

Behavior in games 

Mental, Moral and Social Traits: Circumspect, deliberate, 
thoughtful, thoughtless, impulsive, careless, slothful, slovenly, lazy, 
inert, slow, dull, stupid, apathetic, unresponsive, taciturn, reticent, 
diffident, retiring, bashful, quiet 

Bright, talented, precocious, quick, responsive, talkative, loquacious, 
communicative, entertaining, boring 

Cheerful, good-natured, gay, humorous, kind, affectionate, sympa- 
thetic, helpful, generous, frank, obedient 

Moody, sensitive, despairing, fretful, cranky, resentful, malignant, 
defiant, angry, meddlesome, complaining, quarrelsome, trouble maker, 
brutal, fights, kicks, scolds, nags, spiteful, jealous, sullen, selfish, 
self-centered, proud, domineering, bossy, changeable moods, capricious 
disposition or character 

Graceful, artistic, neat, awkward, clumsy, poor gait, poor motor 
control, stumbles, falls, injures self 

Bold, reckless, heedless of danger, venturesome, blustering, noisy, 
fearsome, cowardly 

Restless, fidgety, nervous, scowls, twitching movements (of what) 
excessive movements, emotional, excitable, 
impulsive, passionate, violent 

Strange or peculiar actions, habits, speech (what) 
Sudden or capricious outbreaks of passion, anger, fear, destructive 
tendencies, love, gaiety, laughing, crying, tantrums, fits, fainting 
spells. Automatic actions (when excited or otherwise) 
Suspicious, solitary, seclusive, shut-in, avoids company, dreamy, 
observant 

Honest, truthful, pure, modest; dishonest, untruthful, steals, lies, 
profane, swears, obscene, lewd, masturbates, immoral 
Any sense of shame, of difference between right and wrong, of guilt, 
remorse, sorrow, reverence, religion 

Speech: stutters, stammers, lisps, lalls, indistinct, inarticulate, 
sluggish, mumbling, thick, incoherent, halting, jerky, rambling, point- 
less, labored ; clear, fluent, logical, sensible, braggadocious, egotistical, 
gossipy; declaims, recites, sings 

Headaches, eyestrain, holds eyes near work, mouth open, poor hearing, 
takes cold easily, running nose, gets sick, tired 
Smokes, chews. Data from school medical record: 



440 MENTAL HEALTH OF SCHOOL CHILD 

What special measures have been taken to overcome the child's 
pedagogical deficiencies ? 
To overcome his physical defects 
His moral or social shortcomings 

Results of These Measures: 

Recommendations : 

Results of Following Recommendations (from later inquiries): 

Signatube : 

FORM V 
PHYSICAL AND ANTHROPOMETRIC EXAMINATION 

No. Diagnosis Examiner Date 

Full name Sex Birthday 

Age: yrs. mos. Address Parents' or 

guardian's name (and address, if different, with 'phone) 

Brought by Referred by 

(Underscore appropriate words: once for 'moderate,' twice for 'marked,' and 
thrice for 'extreme' degree. Supply all relevant data in blank spaces.) 

Defects, Diseases, Disorders and Stigmata 
(Anatomical, physiological, neurological) 

General Appearance: Expression nutrition 

Fat, corpulent, lean, emaciated, fair, normal. 

Skin: complexion; pallid, sallow, ashen, oily, moist, dry, leathery, 
wrinkled, baggy, florid, scars, birthmarks. 

Teeth: carious (number, degree) roots, tartar, 

impacted, irregular, malocclusion, rachitic, serrated, pointed, Hutch- 
inson's Gums 

Tongue: thick, pointed, large, small, furrowed, enlarged papillae. 

Throat: tonsils, enlarged, atrophied, submerged, pitted, soft, 
removed. Pharyngitis. Laryngitis. Mouth breather. Lymph glands. 
Thyroid, enlarged, atrophied. Adenoids. 

Palate: cleft, V-shaped, arched, narrow. 

Lips: normal, hare-lip, thick, thin, everted, fissured. 

Nose: deflected septum, enlarged turbinates, polipi, rhinitis, broad 
base, sunken bones, squat, mongoloid, cretinoid. 

Eyes: acuity, R L Astigmatism Small 

palpebral fissure, exophthalmos, choked disc, scotoma, hemiopsia, 
irregular or eccentric pupils, ptosis, oblique mongolian, epicanthus. 



SCHEMA FOR CLINICAL STUDY 441 

Nystagmus, strabismus, diplopia, accommodation to light to 

distance Argyll-Robertson 

Iris, color, R L Wearing proper or improper glasses 

Ears: acuity, R L Rinne Otitis media, 

R L Impacted cerumen, perforated drum, otorrhea. 

Large, smaU, Darwinian tubercle, lobule absent, fossae absent or irre- 
gular, pinna (size, shape) asymmetries 

Face: immobile, mobile; forehead, Bomb6, receding, low or narrow; 
prognathous jaws, asymmetries 

Head: hydrocephalic, macrocephalic, microcephalic, rachitic, syphi- 
litic, cretinoid, asymmetries. Hair: color coarse, dry, oily, 
scant, brittle. Pediculosis. 

Shoulders: round, square, stooped, asymmetrical. Scaphoid scapula 

Spine: scoliosis C D L lordosis, C D L 

kyphosis 

Chest: flat, rachitic, pigeon, funnel, barrel-shaped, asymmetrical. 
Lungs Respiration, rate character 

Upper Limbs: 

Lower Limbs: 
Flat foot 

Circulation: good, poor. Heart: dilation, murmurs, displacements. 
Pulse: volume rate rhythm pressure Veins 

Arteries Blood examination: red corpuscles 

white corpuscles hemoglobin color index 

Widal Wasserman 

Alimentation: appetite digestion abdomen 

stomach intestines 

Genito-Urinary System: 

Neuro-Muscular: tone, relaxed, flabby, tense. Corrugation, over- 
action of frontals. Tremors, coarse, fine, unilateral, spastic, jerky, 
intermittent, rhythmical, of what parts Hand balance: 

relaxed, tense, drooping, asymmetrical, finger twitches Station: 

relaxed, unsteady. Head balance Gait: normal, lively, 

clumsy, shuffling, spastic, ataxic, waddling. Paralyses 
Contractures Fainting spells Tics 

Habit spasm Convulsions Chorea 

Epilepsy Hysteria Headache, migraine 

Anesthesias 

Reflexes: patellar, R L Clonus Babinski 

Other reflexes Defective speech 

Other Defects or Stigmata: 



442 MENTAL HEALTH OF SCHOOL CHILD 

Active Disease Processes: record the diseases, and indicate whether 
slight or serious, of the integumentary, skeletal, muscular, nervous, 
nutritive, respiratory, circulatory, lymphatic, excretory and repro- 
ductive systems. 

History of Diseases^ Deformities and Accidents, with Previous 
Medical Diagnoses: 

Name of Examiner: 

Physician's Recommendations: 

Results of Recommendations (as later ascertained) : 
Physician or hospital recommended: 

Anthropometric Measurements 

Weight: lbs. kg. Stature, net standing (mm.) 

Sitting Ponderal index Statural index 

Statural type Spread of arms 

Spirometry: 12 3 Chest girth (below level of axillae): 

maximal inhalation exhalation normal Vital index 

Dynamometry: Rl 3 3 LI 2 3 Head 

measurements: circumference height length (antero- 

posterior diameter) breadth cephalic index 

Other measurements 

FORM VI 

PSYCHOLOGICAL EXAMINATION 

It has been deemed wise to omit a schema for conducting psycho- 
logical examinations for the following reasons. First, a considerable 
number of graded scales for testing intelligence (particularly versions 
of the Binet-Simon scale) are now easily accessible in English. 
Second, hundreds of different psychological tests and experiments are 
equally accessible in the standard books dealing with psychological 
tests (e.g., the manuals by Whipple, Franz, Titchener, Sanford, 
Starch, Scripture). It would be futile to attempt to print a selected 
list of such tests here, because the expert experimental psychologist 
is qualified to make his own selection, while the inexperienced 
psychologist (physician, nurse, teacher) would scarcely be able either 
properly to conduct the experiments without technical training, or 
elaborate explanations, or correctly to interpret the findings. Third, 
there is little profit in outlining a comprehensive series of tests until 
reliable clinical norms are available. Unfortimately such norms are 
not yet available. The fact that this is so makes it all the more 



SCHEMA FOR CLINICAL STUDY 443 

necessary that the clinical psycho-educational examiner should possess 
very extensive first-hand experience with many types of mentally 
unusual children, so that he will be able to diagnose cases fairly 
accurately with the aid of a minimal number of tests. 

FORM VII 

PEDAGOGICAL EXAMINATION 

Until we have available a series of clinical pedagogical age-norms, 
in various school studies, established by objective tests given under 
standard and controlled conditions, possibly to individuals rather 
than to groups — such as the Courtis scores in the fundamental mathe- 
matical processes, though these are group norms — it would be of 
little avail to outline a schema for the pedagogical testing of the child. 
We have, to be sure, the pedagogical scales by Vaney and Holmes, 
but the former is very limited in range and not entirely appropriate 
to pupils trained by American school methods, while the latter has 
not been experimentally derived by objectively testing individual 
children of various ages (the method of derivation is not revealed). 
It is merely an abbreviated course of study for grades two to five 
which, it is assumed, represents the pedagogical accomplishments of 
normal children. Until we possess satisfactory pedagogical age scales 
of development, it will be necessary to use (but with discriminating 
judgment) the school record of the child (Form IV). 

FORM VIII 

SUMMARY OF IMPORTANT FINDINGS 

It is very desirable that social or field workers epitomize for the 
busy examiner the chief findings. This blank should be comprehen- 
sive, yet very brief: it should contain only the data which seem to 
have an important bearing on the case, which are important for 
diagnosis and prognosis. It may also include the chief results of the 
physical, anthropometric and psychological examinations, the final 
(or at least the provisional) diagnosis, the recommendations, a record 
of treatment, the results of treatment, and the final disposition of the 
case. 

The question naturally arises whether it is necessary or 
indeed desirable to make such an exhaustive investigation 
of each case as that contemplated by the above schema. 



444 MENTAL HEALTH OF SCHOOL CHILD 

The answer is that it is usually desirable, but not always 
necessary or possible to do so. Unless the clinicist has at 
his command the necessary staff of assistants he must 
content himself with a far less thorough investigation. He 
should, however, at all times attempt to secure a certain 
minimum of data which bear significantly upon psycho- 
educational cases. Such a minimum is represented, I 
believe, by the following abbreviated record blank. It is 
reproduced from the routine blanks which have been in 
constant use in my clinic for several years. 

FORM IX 

ABRIDGED RECORD BLANK 

Child's name (with street and city address and 'phone) 
Parents' names (with address and 'phone, if different) 
Referred by Brought by Date 

Data secured from Recorded by 

Exact age: date of birth Age in yrs. and mos. 

Place of birth Nationality of father of mother 

Language spoken at home 

I. Pedagogical Record 

School now in All schools attended, in correct time 

order, with dates 

Age on entering first school (including kindergarten) 

Number of years (or months) in school Present grade 

In what grade should child be according to age Years 

retarded Number of years (or months) in each grade 

(including kindergarten) 

Grades repeated (indicate whether one, two or three years) 

Will child be promoted this year Attendance 

Greatest capacities, abilities or talents shown in school work (best 

subjects) Greatest interests 

Greatest deficiencies, worst faults, poorest school subjects 

Physical, mental and moral characteristics, disposition, deportment 

Other comments by teachers 
School medical inspection record 
School record of brothers and sisters 



SCHEMA FOR CLINICAL STUDY 445 

II. Home and Environmental Conditions 

Parents alive Living together Breadwinner 

(who) Financial conditions Home sanitary, 

well ventilated, clean In house, tenement, shack, apart- 

ment In good or bad (slummy or immoral) neighbor- 

hood Social or moral conditions in home 

Home treatment (child neglected, cruelly or kindly treated, well 
cared for) What does child usually eat 

What does child drink Hours of retiring and 

arising Does child keep bad company 



III. Child's Developmental History 

Birth conditions: on time premature (how much) 

Labor, how long With instruments Birth 

injuries How nursed (length) 

Health as babe Infant and child diseases (state age, 

severity, after effects): Croup Whooping cough 

Chicken-pox Measles Diphtheria Scarlet 

fever Typhoid Pneumonia C.-s. menin- 

gitis Infant paralysis Spasms (describe) 

Enuresis Accidents By whom previously examined 

and diagnoses given 

First teeth, when (any illness) Fontanel closed 

First stood alone First sat up First steps unsup- 

ported First walked unsupported First used single 

words Short phrases or sentences 

Mental and physical peculiarities in infancy and childhood (age 
first observed): queer or unusual behavior, talk or ideas; emotional 
fits or outbreaks, fears, night terrors, destructive, disobedient, 
vagrancy, truancy, veracity, delinquencies, bad sex habits, social 
traits, play tendencies, stupid, sluggish, quick, bright 



IV. Hereditary Factors 

Health, habits, diseases, drink, etc., of father and mother before and 
during conception 

Pregnancy conditions (overwork, poor health, infection, drink, 
abuse, starvation, etc.) 

Age of mother at child's birth of father Parents 

related 



446 MENTAL HEALTH OF SCHOOL CHILD 



Q3 



Order of child's birth 



Number of Sisters 
Number of Brothers 



Give facts in regard to the following defects, conditions or diseases 
found in the child's brothers, sisters, mother, father, maternal and 
paternal great-grandparents, grandparents, aunts, imcles, first and 
second cousins, etc.: 







>. 




o 




o 


"3 

1 
o 


>>d 


CO 






.2o 


3 
O 
> 
•-< 
v 


3^ 




a 


<A 


o 
,c 
o 
o 

< 


11 

X S 

a; e 


(1) 03 


ca 3 4) 
<u rt be 

Oo<d 


oj 

a 

u 

o 
12; 



























[Copies of the "preceding Schema are available in separate reprints, and 
can he secured from the publisher s,\ 



Note to Chapter IV 

Some unwarranted assumptions and criticisms relating 
to the original of this chapter by one of my reviewers call 
for a brief refutation (E. A. Doll, The Training School 
Bulletin, March, 1914, 10). 

'Possibly Dr. Wallin has again confused cause and 
effect.' My critic assumes (he gives no facts in support of 
the indictment) that my diagnoses are purely 'diagnoses 
by symptoms,' and that I confuse the facts of etiology with 
the facts of symptomatology. A perusal of the article 
will show that it was explicitly affirmed that my 'final 
diagnosis was based on all the available facts,' facts of 
etiology and pathology no less than facts of symptomatol- 
ogy. The symptomatological classification was not based 
purely on symptoms, as the word would indicate unless 
proper regard were given to the statement made in the 
text. 

'Dr. Wallin believes that the percentage (of the feeble- 
minded) is below rather than above 1 per cent, and yet he 
states that "over 10 per cent of all the elementary pupils 
in the Pittsburgh public schools are retarded three years 
or more." This looks very much like a contradiction, since 
feeble-mindedness is defined psychologically as intellectual 
retardation of two years at an age below nine or three 
years at and above nine, which definition the author 
admits in his Experimental Studies.' My reply is threefold. 

First, I do not admit this definition. The statement I 
made in the Experimental Studies (pp. 16, 98, 103) was 
that 'children retarded less than three years should prob- 
ably not be rated as feeble-minded.' Since only nine 



448 MENTAL HEALTH OF SCHOOL CHILD 

epileptic children were retarded less than three years, while 
the average retardation for the epileptics who were classi- 
fied as children was over seven years, I had little need of 
attempting to apply automatically any rigid 'two- or 
three-year standard' of feeble-mindedness. In the Prac- 
tical Guide (p. 116f.) I was careful to avoid laying down 
any arbitrary standard whatever. My experience with 
epileptic and insane patients had aroused my suspicion of 
the propriety of so doing. My later experience with the 
great variety of cases which come to a university clinic 
has convinced me that it is futile to attempt a differential 
diagnosis — even to the extent of differentiating between 
morons and backward persons — on a confessedly artificial 
and arbitrary quantitative standard of intellectual retar- 
dation. In the 1911 scale Binet himself wisely avoids this 
pitfall. He merely states that no child, no matter how 
httle he knows, should be regarded as defective unless his 
intelligence is retarded more than two years. Elsewhere 
he cites the French policy, apparently with approval, of 
not placing a child in a special class for defectives for 
mental retardation alone, unless the retardation amounts 
to three years or more, or to at least two years if the 
child is less than nine. 

Second, the retardation statistics I gave for the Pitts- 
burgh schools refer to pedagogical retardation based 
merely on an age-grade census. As everybody knows these 
surveys include children who are not even genuinely back- 
ward in inherent all-round mental capacity. I merely 
ventured the opinion that one-half of the 10 per cent 
retarded three years or more should be placed in special 
classes, but assuredly not because they were all feeble- 
minded. The special classes in the public schools are 



NOTE TO CHAPTER IV 449 

designed not only for the feeble-minded but also for the 
seriously backward. Under ideal conditions 4 or 5 per 
cent of the elementary pupils should be placed in these 
classes, about one-fourth of these being feeble-minded, 
about one-fourth border-line cases and about one-half 
seriously backward. 

Third, no one who defines feeble-mindedness as 'intellec- 
tual retardation of two years at an age below nine, or 
three years at and above nine' has had the courage to 
follow this definition to its inevitable conclusion. It is 
indeed amusing that the advocates of tliis arbitrary stan- 
dard tell us that only 2 per cent of the elementary school 
population is feeble-minded. (Possibly they have merely 
accepted an old English conjecture. As long ago as 1906 
Dr. James Kerr, chief medical officer for the London 
County Council Schools, made the same estimate for a 
committee of inquiry, but he included in his estimate other 
types of mental defectives than those actually feeble- 
minded.) Why do they not announce that 8.4 per cent of 
the grade pupils are feeble-minded, for Goddard found 
that this percentage of all the pupils in the first six grades 
in a given township were retarded from three to seven 
years by the Binet scale .? Not only so, if we assume that 
one-fifth of those retarded two years were 'at an age 
below nine,' the number of feeble-minded would be 10.4 
per cent, instead of 8.4 per cent — or 2 per cent! Are 
those who defend the 'amazing accuracy' of the automaton 
method of diagnosticating feeble-mindedness prepared to 
follow their method to its inescapable conclusion.'' Are 
they prepared to stand 'by [their] experimental facts 
instead of preconceived notions as to possibility or impos- 
sibility' .^^ Are they ready to present incontestable facts to 



450 MENTAL HEALTH OF SCHOOL CHILD 

show that the standard which they adopt is not itself 
nothing but a *preconceived notion'? If there is a magic 
infallibility about this standard, why do they not formu- 
late the standard in precisely the same terms? Doll has 
one standard; Goddard has another, to wit: 'If a child is 
more than two years backward while he is still under nine 
years of age, . . . . he is probably feeble-minded. For a 
child above nine [how about the nine-year old?] we allow 
him to be more than three years backward before we call 
him defective' (italics mine). Does more than three years 
backward mean three years and one point or four years? 
We seek in vain for an answer. Contrast this standard 
with Doll's dictum given above and note the difference. As 
I have frequently stated elsewhere in this book, my 
attempt to apply arbitrary quantitative standards of 
intellectual retardation in the diagnosis of the varied cases 
coming to a university clinic in a populous district has, in 
the main, proved quite futile. I have had numerous 
mentally abnormal cases retarded from five to sixteen years 
by the Binet tests whom I should hesitate to call feeble- 
minded. 



INDEX 



INDEX 



Abortion, 250, 261. 

Accelerated pupils, prevalence, 

105. 
Acceleration, kinds, 101. 

pedagogical, 7, 144. 
Adler, 34. 
Ages, kinds, 101. 
Age-norms, 111, 229. 
standard of, 204f. 
see norms, mental norms. 
Age-scales, kinds, 166f. 
Age standards, inequalities in 

Binet, 202. 
Alcohol, and deficiency, 272f. 
and heredity, 261. 
and racial deterioration, 258, 
266. 
American productivity, 237. 
Amateur, diagnosis, 379. 

psychological diagnosis, 75, 137, 
142, 148, 151, 157f, 164, 209f, 
21 If, 218f, 220, 393f. 
testers, 75, 209f, 211f, 218f, 
220. 
Anatomical age, 102. 
Anderson, 34, 75. 
Anthropometric, examination, 

106f. 
norms, 184. 
record blank, 440f. 
Aphasic imbecile, 342f. 
Arrest of development, 125f. 
Attendance, causes of irregular, 

318, 320. 
Ayres, 105, 241f, 305, 311, 320, 
335f. 

Backward children, public school 
classes for, 384f, 387f. 
training for, 386 f. 
see feeble-minded, mentally ex- 
ceptional children. 
Backward delinquent, 369f. 
Bailey and Babette Gatzert Foun- 
dation, 27. 
Beanblossom, 78. 



Behavior, determination of, 124. 

Benedickt, 131. 

Berry, 42. 

Binet, 229. 

Binet testers, role, 211f. 

in schools, 393f. 

extent of training, 395. 

see amateur. 
Binet-Simon, curve of distribu- 
tion, 184f. 
Binet-Simon scale, 139f, 173. 

accuracy of, 143f, 173, 190f, 
201, 214f, 268, 449. 

advance accrediting, 175, 191f, 
197. 

age inequalities in, 190, 202. 

automatic diagnosis by, 215. 

basis of accrediting, 175. 

coaching, 173f. 

difficult ages, 191f. 

discrepancies in rating, 49f, 
146f. 

edition of 1908, 223f. 

exploitation of, 140. 

functions of, 141, 174. 

improvement of, 226. 

inadequate revisions, 223f. 

infallibility of, 103, 143, 208, 
214f. 

methods of revision, 175. 

methods of testing accuracy of, 
143f, 190f, 196f. 

misconceptions regarding, 141 f, 
209 f. 

mislocations of tests, 203f. 

number of tests in each age, 
227. 

present status of, 196f. 

sources of inaccuracy, 190f. 

standards of passing, 204f. 

standardized administration, 
226 f. 

time to administer, 114. 

valid tests of, 197. 

value of, 141, 194, 205f, 215. 

wide-range testing, 175f. 



454 



INDEX 



Binet-Simon testing, results of, 

182f. 
Biographical charts, 270f. 
Bismarck, 231. 
Blan, 241 f. 

Blind, classes for, 131, 426. 
Boas, 342. 
Bobertag, 117, 197. 
Boehme, 117. 
Bonus system, 235. 
Bosworth, 34. 
Bottger, 84. 
Bowditch, 184. 
Brandeis, 235, 243. 
Breast feeding, 251, 253. 
Breese, 34. 

Bricklaying operations, 231. 
Bright children, classes for, 427. 

physical defects of, 300f, 
Brill, 69. 

Browne, 238f, 243. 
Bruner, 41, 90, 219. 
Bryan, 303. 
Bureau of school research, 89f. 

director of, 94. 

possibilities of, 93f. 
Burnham, 221. 
Business efficiency, 236. 
Bunge, 261. 

Caffeine, mental effects of, 240, 

272f. 
California health development 

law, 92f. 
Carriers, anti-eugenic, 268. 
Cases, basis of selection, 124. 
grouping of, 125. 
for psycho-clinicist, 160. 
Case histories, authors, 340f. 
Cattell, 74, 117, 236f, 243. 
Causation, kinds, 124. 

see psychogenic causation. 
Child examiners, requirements of, 

92. 
Child growth, supervision of, 253. 
Child, orthogenesis, 246. 

see orthogenesis, orthophrenics, 
orthosomatics. 
Child welfare in schools, 337f. 
Childs, 322. 

Chronological age, 101. 
Classes for training subnormal 
children, 67f. 



Classification, educational, 160. 
inadequacy of pedagogical, 14, 

161f. 
individual, 149. 
of cases, 143f, 149f, 337f. 
of subnormals, 14. 
Clearing house, psychological 
clinic as, lllf. 
in schools, 101. 
Cleveland, dental experiment, 257, 
275f, 291f, 313. 
dental squad, 172. 
Cleveland schools, dental and 

medical inspection in, 315f. 
Clinic cases, 337f. 
Clmical, diagnosis, 220f (see 
mental diagnosis), 
method, 23, 115. 
norms, from group tests, 215, 
220. 
Clinical psychologist, 394. 
qualifications of, 114f. 
research functions, 220. 
training needed, 134, 136, 142, 

210, 216f, 220. 
see amateur psychological 
testers 
Clinical psychology, 20, 22f, 121f, 
156f. 
aims, 123f. 
claims, 121. 
courses in, 25f. 
and education, 89 f. 
and educational psychologist, 

216, 220. 
and experimental psychologist, 

216, 220. 
field of, 123. 

functions of, 123, 137f, 182. 
and eenetic psychology, 216. 
and medicine, 54, 135, 159, 163. 
preparation in, 115. 
and the psychologist, 55. 
relations of, 132. 
relations to school hygiene 

movement, 156f. 
standards of, 211. 
and the teacher, 217f. 
Clinical schema, 429f. 
Clinical testing technique, 222. 
Community, conservation, 246f. 
orthogenesis, 294. 



INDEX 



455 



Compulsory medical treatment, 

17. 
Concord reformatory, 78. 
Conservation, 231f, 246. 

child, 156, 294. 

human, 246f. 

of mental health, 337f. 

research in, 270f. 

see efficiency. 
Contagious diseases, 1. 
Coriat, 69. 

Cornell, 97, 301, 304f, 312, 335. 
Cornman, 242. 

Corrective pedagogics, 117, 153, 
156, 159, 164f, 217, 339, 377f. 

see orthogenesis, orthophrenics, 
mental hygiene. 
Correlation, method, 222. 

of physical and mental defects, 
7f. 
Courses, in clinical psychology, 
25 f. 

on exceptional children, 25f, 71. 
Courtis, 241, 243. 
Criminal municipal courts, Bos- 
ton, 75. 

Chicago, 399. 

Cleveland, 399. 
Criminality, 80, 166f, 180. 

and heredity, 260. 

juvenile, 8f. 

study of, 78f. 

see defective delinquent. 
Criminology, Italian school, 99. 
Cronin, 128, 313. 
Curve of distribution, Binet, 184. 

normal, 109, 199. 

Davenport, 239, 243. 
Deaf, 131. 

classes for, 425. 
Dearborn, 117. 
Dearborn, W. F., 34. 
Decroly, 197. 
Defective children, menace of, 9. 

delinquent, 366 f. 

see criminality. 
Defectives, interest in, A"II. 

vagueness of term, 386. 
Degand, 197. 
Delinquent types, 366 f. 



Dental defects, evils of, 334. 
prevalence of, 2f, 329f. 
see dental hygiene. 
Dental dispensaries, free, 295. 
Dental hygiene, 257, 275f, 291, 
313f. 
financial value, 296f. 
graphs, 284f. 
mental effects of, 281 f, 288f, 

291 f. 
national campaign for, 276. 
values, 296. 
see dental defects. 
Dental inspection, statistics from, 
334. 
in Cleveland schools, 315f. 
Dental surveys, 328f. 
Dental treatment, effects of, 332, 
334. 
see dental hygiene. 
Development supervision, 253f, 

270. 
Developmental, history, 98. 
norms. 111 (see norms), 
record, 431 f, 445. 
Diagnosis, differential, 141. 
mental, 123. 

psychological, 158 (see educa- 
tional and mental diagnosis). 
Differential pedagogical treat- 
ment, see corrective peda- 
gogics. 
Disciplinary pupils, classes for, 

423 f. 
Discrepancies in Binet rating, 
175. 
see Binet-Simon scale. 
Doll, 71, 447, 450. 
Dubois, 63, 117, 130. 
Duncan, 260. 
Dynamometry, 171. 

Ebersole, 293, 336. 

Education as adjustment, 338, 

378. 
Educational clinics, in schools, 
379. 
administrative control of, 379. 
see psychological clinics. 
Educational diagnosis, 56, 138, 
340, 355, 378f, 393. 
see mental diagnosis, psycho- 
logical examination. 



456 



INDEX 



Educational orthogenesis, 125. 

see corrective pedagogics, or- 
thophrenics. 
Educational psychologist, 216, 

220. 
Educational psychology, and clin- 
ical psychology, 136. 
Educational waste, 337 f. 
Educators, as psychological 
examiners, 396. 

see Binet testers. 
Efficiency, age curves, 199f. 

individual curves, 206. 

individual and group, 231f. 

pedagogical, 242. 

school, 240. 

in school organization, 337f. 

scientific, 231. 
Elementary industrial classes, 

387. 
Ellis, 79. 

Ellis Island, 88f, 399. 
Elson, 336. 

Emerson, H., 234, 243. 
Emerson, L. E., 70. 
Emery, 336. 

Environmental blank, 435f, 445. 
Epilepsy, 131, 167, 169, 176f, 
182f. 

and heredity, 260. 

mental wreckage from, 191, 
193. 

treatment of, 357f. 
Epileptic colonies, psychological 

clinic in, 70. 
Epileptic curve, factors of, 186f, 
201f. 

skewed character, 190. 
Epileptic imbecile, 356f. 
Epileptics, 143. 

classes for, 423. 

distribution, 185f. 

intelligence of, 186f, 188f. 

mental deficiencies of, 193. 
Etiology, 123. 
Eugenics, 240, 246f, 291. 

and child study, 258. 

diagnostic difficulties, 267f. 

experimental difficulties, 269. 

and infant mortality, 259f. 

and instincts, 264f. 

legal factors, 267. 

measures, 262f. 



obstacles, 263f. 

psychological factors, 264f, 268. 
research in, 270f. 
Euthanasia, 247. 
Euthenics, 246 f, 291. 

and infant mortality, 249f. 
Examination, guide for, 429f. 
of subnormal children, school 

statistics of, 392f. 
psychological, 2f, 12 (see psy- 
chological and educational 
diagnosis and examination). 
Exceptional children, changing 
attitude toward, 90. 
examination of, 14 f (see psy- 
chological and educational 
diagnosis), 
types, 121. 
Exclusion from school, and phys- 
ical defects, 315f, 318f. 
Experimental genetics, 269. 
Experimental pedagogy, depart- 
ment of, 100. 
Experimental psychologist, 216, 

220. 
Experimental psychology, and 
clinical psychology, 136. 

Family charts, 98. 
Family history blanks, 433f, 445. 
Farrington, 73. 
Feeble-minded, 19, 112, 161. 

Binet statistics of, 133. 

colonization of, 19. 

distribution of, 186. 

need of oversight, 365f. 

prevalence of, 148f, 447f. 

public school provisions for, 
384f. 

school efficiency of, 169, 176. 

selection of, 19. 

social study of, 166f, 180. 

study of, 166. 

treatment of, 125f. 

see mentally exceptional chil- 
dren. 
Feeble-minded institutions, psy- 
chological study in, 70, 382, 
399. 
Feeble-mindedness, and alcohol, 
261. 

definition of, 447f. 

diagnosis of, 133f. 



INDEX 



457 



diagnostic difficulties, 161f, 
450. 

and epilepsy, 186f. 
and heredity, 260. 

industrial incompetence of, 
168f, 178, 365f. 

institutional provisions for, 347. 

intellectual arrest of, 149f, 170. 

legal questions concerning, 166. 

menace of, 19. 

nature of, 125, 149f, 170. 

a pedagogical question, 125f. 

personal efficiency of, 167, 180. 

a quantitative variation, 386. 

standard of, 188f, 450. 
Fernald, Grace, 44. 
Fernald, Guy G., 78. 
Fletcher, 35. 

Foreigners, classes for, 425. 
Form board, 171, 343f. 
Forsyth dental clinics, 334. 
Foster, 117. 
Franz, 62, 70, 117. 
Free dental dispensaries, 11, 334. 
Free dispensaries, 256. 
Free dental and medical treat- 
ment, 11. 
Freud, 62f, 69, 106, 130. 
Friend's Asylum, 70. 

Gallon, 184. 
Gantt, 235, 243. 
Gayler, 118, 302. 
Genius, 238, 260. 

schools' duty toward, 377f. 
George Junior Republic, 37. 
Gesell, 33, 51. 
Gilbreth, 231. 
Goddard, 38, 71, 118, 186, 197, 

202, 225, 239, 243, 449 f. 
Goldmark, 235. 
Greene, 336. 
Groszmann, 73, 120. 
Group, results, 221. 

tests, 220. 
Growth defects, 308, 310. 
Gulick, 118, 336. 

Haberman, 49. 
Hastings, 343. 
Hayes, 237, 243. 
Healv, 34, 75. 
Heilman, 44, 306, 308. 



Heredity, 247f. 

blank, 433f, 445. 

and capacity, 262. 

and environment, 98. 

investigations, inaccuracy of, 
430. 

of talent, 237f. 
Hickling, 52. 
Hickman, 273. 
Hicks, 93. 
Hickson, 71. 

Hilfsschule in Germany, 390. 
Hill, 35, 79. 
Historiometry, 237f. 
Hoch, 69. 

Hollingworth, 240, 243. 
Holmes, Arthur, 120, 336. 
Holmes, W. H., 120. 
Holt, 249. 

Home record of child, 435 f, 445. 
Hospital school, 24. 
Huey, 30, 72, 118. 
Human efficiency, 231 f. 

study of, 166f. 
Hygiene, mouth, 240. 

see dental hygiene. 

Ideogenic causation, 134. 

see psychogenic causation. 
Imbecile, aphasic, 342f. 
excitable, 344f. 
mongolian, 347f. 
quasi-microcephalic, 351f. 
in schools, 341, 346. 
Immigrants, and illiteracy, 87. 

menace of defective, 89. 
Immigrant stations, and psycho- 
logical diagnosis, 86f. 
Improvement, measuring scales 

of, 226. 
Incestuous intercourse, 264f. 
Indices, anthropometric, 184. 
Individual, differences, 123, 282. 

psychology, 20. 
Industrial competency of sub- 
normals, 83. 
see feeble-minded, feeble- 
mindedness. 
Industrial efficiency, 168f, 176, 

178. 
Industrial scales, 226. 
Inebriety, and infant mortality, 
250. 



458 



INDEX 



Infant mortality, 246f. 
causes, 249. 

euthenical measures, 250f. 
factors, 273. 
reduction in, 252f. 
Insane, treatment of, 130. 
Insane liospitals, psychological 

clinics in, 68. 
Insanity and heredity, 260. 
Inspection, medical and psycho- 
logical. Iff, 252. 
see dental. 
Institutions as research labora- 
tories, 73. 
Intellectual efficiency, 170f, 176f. 
Intelligence, of feeble-minded 
and epileptics, see feeble- 
minded and epilepsy, 
measurement of, 103. 
Introspective psychology, and 

clinical psychology, 136. 
Isaacs, 35. 
Itard, 125. 

Janet, 130. 

Jelliffe, 69. 

Jessen, 333. 

Jones, 61, 69, 118, 130. 

Johnson, 38. 

Johnston, 71. 

Johnstone, 191, 197, 202. 

Jung, 62, 106. 

Jurisprudence and psychology, 
80. 

Juvenile courts, psycho-clinics in, 
74, 383, 399. 

Juvenile delinquents, examination 
of, 76. 
problem for schools, 75f. 
see criminality, defective delin- 
quent. 

Juvenile Psychopathic Institute, 
Chicago, 75. 

Katatonia, 207. 
Kaye, 262. 
Kellogg, 262. 
Kerr, 449. 
Keyes, 241, 244. 
Kiernan, 238, 244. 
Klein Smid, 78. 
Kohnky, 314. 



Kraepelin, 69. 
Kuhlmann, 29, 72, 118. 

Laggards, 16. 

removal from regular grades, 
16. 

see backward children, feeble- 
mindedness, retardation. 
Langmead, 210. 
Latenen, 261. 
Latent complexes, 62f. 
Leslie, 93. 

Literacy, tests of, 87. 
Lombroso, 99. 
Longitudinal analysis, 124. 
Lonnett, 261. 

Madigan, 52. 
McHenry, 336. 
MacMillan, 90, 119. 
Marriage, early, 260. 
eugenic, 262f, 264f. 
Maternal diaries, 270. 
Mating, eugenic, 291. 

factors of, 265. 
Mean variations, between Binet 

tests, 203, 206. 
Measuring scales, improvement 

of, 226. 
Medical consultants, 159. 
Medical inspection. If, 255f. 
administrative control of, 327. 
in Cleveland schools, 315f. 
defects of, 255. 
functions of, 1. 
indefinite standards, 12, 97, 

322 f. 
problems of, 95f. 
and psychological diagnosis, 
396f. 
Medical record blank, 440f, 445. 
Medical and psychological in- 
spection of school children, 
If. 
see psychological examination. 
Medical schools, psycho-clinical 

work in, 49f. 
Medical schools, and psychology, 

61. 
Medical specialization, 339. 
Medicine, and clinical psychology,^ 
135. 
see clinical psychology. 




<^"^X^' 



INDEX 



459 



Memory span, in epileptics, 193. 
Mendelism, 269. 
Mental arrest, 134. 

see feeble-niindedness. 
Mental defectives, scientific train- 
ing of, 12. 
see backward, feeble-minded, 
mentally exceptional children. 
Mental development norms, 238. 
Mental deviations, 12. 
Mental diagnosis, 138f, 209f, 213, 
218. 
authoritative, 151. 
etiological, 152. 
fallacious, 161. 
individual, 149. 
and medical inspectors, 214. 
pernicious, 149. 

see educational and psycholo- 
gical diagnosis. 
Mental health, conservation of, 

337f. 
Mental hygiene, 62f, 130, 182, 374. 

see corrective pedagogics. 
Mental norms, 16, 215, 220f. 

see age-norms, norms. 
Mental, testing, inadequacy of, 
219. 
traits, unit characters, 269. 
variations, 123, 125, 132, 138. 
wreckage in epileptics, 191, 193. 
Mentally exceptional children, 
153. 
examination of, 12, 17. 
school provisions for, 383f. 
treatment of, 164. 
types of examiners needed for, 

164. 
see backward, feeble-minded 
children. 
Merrifield, 78. 
Method of testing, 190f. 
Methods of testing measuring 

scales, 196 f. 
Meumann, 119. 
Meyer, 30, 69, 130. 
Miner, 29. 
Mirick, 381. 

Misconceptions regarding Binet 
scale, 209f. 
see Binet-Simon scale. 



Misfit pupils, 337f. 

see backward, feeble-minded, 
mentally exceptional chil- 
dren. 
Modifiability of behavior, 124. 
Mongolian imbecile, 347. 

mentality of, 349. 
Montessori, 126, 131, 343. 
Moron types, 358f. 
Motor scale, 178f. 

see industrial efficiency. 
Mouth hygiene, see dental hy- 
giene. 
Munro, 61, 119. 
Miinsterberg, 119, 236. 

Narrow-range testing, 175. 
National Association for the 
Study of Exceptional Chil- 
dren, 73. 
National Dental Association, and 

oral hygiene, 323. 
Native capacity, 174, 227. 
Neurologist, and clinical psychol- 
ogy, 217. 
and psycho-educational exami- 
nation, 158. 
Neurology, 134. 
New Jersey, care of exceptional 

children, 381. 
Newmayer, 304. 

New York, Laboratory of Social 
Hygiene at Bedford Hills, 
78. 
Normal age-norms, 229. 
Normal child, 16. 
physically, 311. 
standard of, 197f. 
Normal norms, 108f, 229. 
Normal schools, psychological 

clinics in, 44f, 58, 382, 399. 
Normal variation, standard of, 

204. 
Normality, criteria of, 109. 
Norms, clinical, 220f. 
half-yearly, 111. 
infant and adult, 110. 
mental development, 171 f, 183f. 
pedagogical, 107. 
psychological, 111. 
see mental norms, normal 



^' 



T 



460 



INDEX 



Observation, method of, 138f. 
Open-air schools, 428. 
Oral hygiene, 240. 

national campaign for, 328. 

see dental hygiene. 
Oral orthogenesis, see dental 

hygiene. 
Orr, 336. 

Orthogenic classes, see special 
classes. 

school, 24. 
Orthogenics, 159, 275, 312f. 

see orthophrenics. 
Orthogenesis, 138, 182. 

infant, 246f. 

process of, 125. 

program of, 255f. 
Orthopedic classes, 427. 
Orthophrenics, 125, 156, 159f, 
239f, 246, 289f, 291f, 313. 

measurement of, 275, 292, 300f, 
312, 325. 

see corrective pedagogics, men- 
tal hygiene. 
Orthosomatics, 127f, 156, 239, 
246, 312. 

and age differences, 281. 

and sex difPerences, 281. 

see orthophrenics. 
O'Shea, 139, 238, 244. 
Osier, 293. 
Otis, 79. 

Parole, 76. 

Paschal, 78. 

Paternalism, 254. 

Pearson, 259. 

Phelan, 37. 

Physical defects, and corrective 

pedagogic treatment, 128. 
Pinard, 250. 
Precocity, healthy type, 375 f. 

nervous type, 374f. 

pathological type, 372f. 
Premature births, 250, 261. 
Prince, 69, 130. 

Prostitutes, feeble-minded, 149. 
Public institutions, as labora- 
tories, 180. 

research bureaus in, 89 f. 
Public schools, conservational 
function, 270, 338. 

new functions, 338. 



provisions for mentally excep- 
tional children, 383f. 
psycho-educational clinic in, 

89 f. 
training of exceptional chil- 
dren in, 68, 383f. 
Pupil inspection, see dental and 
medical inspection, psycho- 
clinical, psycho-educational, 
and psychological examina- 
tion. 

kinds, 156f, 
Pupil record cards, 95f. 
Pseudo-experts, 161. 

see amateur testers. 
Psychasthenia, 150. 
Psychiatric clinics, 152. 
Psychiatrist, and clinical psy- 
chology, 217. 
Psychiatry, 132f. 
Psycho-analysis, 62f, 69. 
Psycho-clinical examination, aims 
of, 160. 
nature of, 429 f. 
records, lOOf. 

see psychological examination, 
clinical psychology. 
Psycho-clinicist, 22, 124. 
Psycho-educational clinics, 14, 21, 
138. 
contributions of, 156. 
see educational and psycholo- 
gical clinics. 
Psycho-educational diagnosti- 
cians, 393f. 
see educational and mental 
diagnosis. 
Psycho-educational examiners, 
competent, 66. 
see clinical psychologist, psy- 
chological examiners. 
Psycho-educational laboratory, 
in schools, 103f. 
functions, 106f. 
Psychogenic causation, 62f, 69, 
130, 134. 
see causation. 
Psychological clinics, 14f, 21, 
137f, 156f. 
affiliations of, 58 f, 93, 214, 397. 
clearing-house function of, 18, 
111, 121, 152f. 



INDEX 



461 



departmental connections, 58f, 

93, 214, 397. 
enumeration of, 57, 382, 399. 
functions of, 113, 137f, 154, 

157f, 396. 
qualifications of director of, 

113. 
research functions, 154. 
spread of, 23f. 
standards of, 54f. 
statistics of, 382, 399. 
and supervision of special 

classes, 114. 
table of, 399. 
teaching function, 113. 
and vocational guidance, 113. 
see psycho-educational clinic. 
Psychological clinics, in criminal 

courts, 75, 399. 
in feeble-minded institutions, 

70, 382, 399. 
in immigrant stations, 86f, 399. 
in insane hospitals, 68, 382, 399. 
in juvenile courts, 74, 382, 399. 
in medical schools, 58 f, 382, 

399. 
in normal schools, 44f, 58, 382, 

399. 
in penal institutions, 78, 382, 

399. 
in psychological departments, 

27 f, 382. 
in public schools, 89f, 103f, 214, 

382, 397f. 
in reformatories, 78, 382, 399. 
in schools of education, 27f, 

58f, 382. 
in universities, 27f, 57, 382, 399. 
in vocational guidance bureaus, 

81. 
Psychological, age, 102. 
development norms, 269. 
diagnosis, 268, 396 (see mental 

diagnosis). 
Psychological examination. If, 12, 

16f, 20, 87f, lOOf, 105, 209f, 

255f, 442. 
and amateurs, 75 (see ama- 
teur), 
misconceptions regarding, 141 f. 
nature of, 106. 
school statistics of, 393f. 
transcript of, 18. 



whom to examine, 14, 16f, 104f, 

163. 
see psycho-clinical examination. 
Psychological examiner, training 
needed, 163f, 210f, 212f, 394f. 
Psychological tests, 326. 

of dental hygiene, 275f, 293f, 

313. 
of physical defectives, 309 f. 
Psychologist, functions, 121f, 
137f, 156f, 182. 
position in institutions, 73. 
and psycho-educational diag- 
nosis, 158. 
Psychology, applied, 22. 
clinical value, 20. 
courses in medical schools, 60 f. 
scientific, 22. 
Psycho-neuroses, 63. 
Psychopathology, 133. 

and psycho-clinical examina- 
tion, 158. 
Psychotherapy, 62f. 
Psvchotics, incipient, 130. 
Pyle, 31. 

Quetelet, 260, 343. 

Race, conservation, 246f, 291, 
294, 298. 

improvement, 240, 258. 
Racial, efficiency, conservation of, 
239. 

indices, 110. 
Rapeer, 4. 
Rate of mental development, 

tests of, 171f. 
Record blanks, 431 f. 
Record charts, 95. 
Records of physical defects, 327. 

chaotic condition of, 323f. 
Reformatories, psychological 

clinics in, 78, 382, 399. 
Repeaters, 306. 
Repetition, cost of, 297. 
Reply to criticisms, 447f. 
Research function of psychologi- 
cal clinic, 182. 
Retardates, 126, 133. 

average defects among, 307. 
Retardation, 296, 300f. 

causes, 102, 105, 320. 

and dental hygiene, 289, 291f. 



462 



INDEX 



kinds, 101. 
pedagogical, 144. 
and phj^sical defects, 300f. 
prevalence of, 91, 104f. 
see backward and feeble- 
minded children. 
Revisions of Binet scale, 223f. 
Rice, 242. 
Rogers, 70. 
Rosanoff, 70. 

Rural districts, medical inspec- 
tion in, 10. 
Russell Sage Foundation, 10, 15, 
108. 

Salaries, of special class teachers, 

400f, 418. 
Schafer, 260. 

Schema for clinical study, 429 f. 
Schlapp, 50. 
Schmidlapp Bureau, 86. 
Schmitt, Clara, 90, 119. 
Schmitt, A. Emil, 128. 
Scholarship, and physical defects, 

301 f. 
School, conservational functions 
of, 254f. 

dentists in, 10. 

dental clinics in, 240, 332f. 

dental dispensaries in, lOf. 

efficient organization of, 241, 
253, 337. 

efficiency, 169, 176. 

feeding,' 320. 

functions of, 11, 16. 

hygiene, 156. 

inadequate means of classifica- 
tion in, 14, 162. 

inspection, 1. 

medical dispensaries, 9f. 

medical inspection, 9f. 

nurses, lOf, 317f. 

progress and physical defects, 
310. 
Scoring, method of, 201f. 
Scott, 236. 
Seashore, 228. 
Sedgwick, 29. 
Segregation of unfit, 13, 257, 263, 

266f. 
Seguin, 125. 
Sex differences, 281. 



Shop management, 234f. 

Sidis, 69. 

Skewed curve, 201 f. 

causes of, 190f. 
Smedley, 107f, 184, 229, 309, 342. 

criticism of norms of, 107f. 
Smith, 28, 75. 
Sneed, 336. 

Social efficiency, 167f, 180. 
Social factors, 98. 
Socio-industrial age, 102. 
Sociological data, 98. 
Southard, 34. 
Special classes, 17f. 

cities reporting, 388. 

efficiency of graduates from, 
83. 

enrollment per class, 389f. 

functions of, 448. 

in higher institutions, 68. 

methods of organization, 391. 

in public schools, 383f, 405f. 

supervision of, 114. 

tabulation of, 405f. 

teachers in, 114. 
Special class teachers, 114. 

salaries, 400f, 418. 

standards of preparation, 401f. 

training of, 400f, 419. 
Special schools, advantages and 
disadvantages, 391f. 

as clearing house, 112. 
Special school centers, 390. 
Speech defectives, 129. 

classes for, 426. 
Speech development, 358f. 
Spelling efficiency, 242. 
Standardized technique, 236f. 
Statistics, of dental defects, 2f, 
329 f. 

of physical defects, 2f, 300f, 
321 f. 

of special classes in public 
schools, 383f, 385, 405f. 

of psychological clinics (see). 
Sterilization of unfit, 239, 263, 

266f. 
Stern, 238, 244. 
Still births, 261. 
Stoelting Co., 173, 278. 
Strayer, 241, 244. 
Stuttering, theories of, 129. 



INDEX 



463 



Subnormal children, 104. 

classification of, 14. 

examination of, 408f. 

menace of, 91. 

misfits in regular grades, 390. 

prevalence of, 90f. 

types, 341 f. 

see backward and feeble- 
minded children. 
Suggestion, 63f. 
Sullivan, 261. 
Supernormal children, 104, 128. 

schools' obligations toward, 
377. 

types, 372 f. 
Sylvester, 36. 

Symptoms, diagnosis by, 447. 
Syphilis, 260. 

Taboo, eugenical, 264f. 
Tabulation of special public 

school classes, 405f. 
Talbot, 237, 244. 
Talent, conservation of, 236. 
Taussig, 324f, 336. 
Taylor, 61, 119. 

Charles Keen, 272. 

Frederick W., 232. 
Teeth, see dental defects, dental 

hygiene. 
Terman, 31. 

Terman and Childs, 118. 
Testing, inadequacy of, 209, 213. 

of measuring scales, I96f. 

method of, 190f. 

narrow-range type, 197f. 

wide-range type, 191. 
Tests, necessary number, 227. 

unreliability of, 151, 

value of, 139, 142, 151 f. 
Thorndike, 222, 241, 247. 
Tobacco, efi'ects of, 272f. 
Todd, 36. 

Town, 72, 119, 224. 
Training psycho-clinics, 65f. 
Trait norms, 228. 
Traits, tests for individual, 171 f. 
Tredgold, 260. 
Trettien, 30. 
Truancy, 8. 
Truants, 75f. 

classes for, 423f. 
Tuberculosis, 260. 



Unfit, elimination, 247. 
Ungraded classes, 384f, 387, 402f, 
420 f. 

confused functions of, 402f. 

enrollment permitted in, 403. 

organization of, 402f. 

teachers' qualifications in, 404. 
Universities, psychological clinics 
in, 22f, 382, 399. 

and scientific work, 74. 

Vagrancy, 8. 

Van Sickle, 241, 244. 

Variation, maximal, 205. 

normal, 197, 205. 
Vocational bureau, functions of, 
81. 
misnomers, 85. 
Vocational efficiency, 234f. 
Vocational guidance, blundering, 
358f, 36 If, 365. 
and psychological diagnosis, 81, 
113. 
Vocational talents, determination 

of, 85. 
von Moltke, 231. 

Wagner, 119. 
Walker, 78. 

Wallin, 32, 119, 240f, 242, 244f, 
estimate of physical defects, 5. 
Weidensall, 78. 
Weisenberg, 323. 
Wells, 70. 
Wernicke, 69, 260. 
Whethams, 237f, 245. 
Whipple, 37, 119. 
White, 52, 69. 

Wide-range testing, 201, 225. 
Wile, 163. 
Williams, 69. 
Winch, 242, 245. 
Witmer, 23f, 27, 120f. 
Woodrow, 29. 
Woods, 237 f, 245, 299. 
Woodworth, 237, 245. 
Woolley, 86, 120. 
Wylie, 70. 

Yerkes. 34. 
Young, 51. 

Ziehen, 69. 



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